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Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement

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Abstract

Summary

Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.

Material and methods

All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.

Results

Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.

Conclusion

Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.

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Acknowledgments

We would like to thank Ph Robinson for manuscript revision—Hospices Civils de Lyon, DRCI.

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Authors and Affiliations

  1. Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France

    J. Perinel, G. Nappo, M. El Bechwaty & M. Adham

  2. Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France

    J. Perinel, M. El Bechwaty, T. Walter, V. Hervieu, P. J. Valette, P. Feugier & M. Adham

  3. Hospices Civils de Lyon, Department of Digestive Oncology, Edouard Herriot Hospital, Lyon, France

    T. Walter

  4. Hospices Civils de Lyon, Department of Pathology, Edouard Herriot Hospital, Lyon, France

    V. Hervieu

  5. Hospices Civils de Lyon, Department of Digestive Radiology, Edouard Herriot Hospital, Lyon, France

    P. J. Valette

  6. Hospices Civils de Lyon, Department of Vascular surgery, Edouard Herriot Hospital, Lyon, France

    P. Feugier

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  1. J. Perinel
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Correspondence to M. Adham.

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Conflict of interest

M Adham declares that he has no conflict of interest.

J Perinel declares that she has no conflict of interest.

G Nappo declares that he has no conflict of interest.

M El Bechwaty declares that he has no conflict of interest.

T Walter declares Clinical Research Grant from INCa (Institut National du Cancer), Travel grants from Novartis, Ipsen and Pfizer.

V Hervieu declares that she has no conflict of interest.

PJ Valette declares that he has no conflict of interest.

P Feugier declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Perinel, J., Nappo, G., El Bechwaty, M. et al. Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement. Langenbecks Arch Surg 401, 1131–1142 (2016). https://doi.org/10.1007/s00423-016-1488-y

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  • DOI: https://doi.org/10.1007/s00423-016-1488-y

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