Survival After Pancreatectomy With Major Arterial Resection and Reconstruction
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Absence of major arterial tumor involvement has generally been regarded as a major criterion for resectability of pancreatic tumors. We hypothesize that resection of a tumor-involved hepatic artery (HA) or celiac artery (CA) with reconstruction may offer a survival benefit to patients whose tumors were traditionally regarded as unresectable.
All patients with pancreatic adenocarcinoma treated between 1996 and 2007 were reviewed. Patients were included if they underwent resection of the HA or CA during pancreatectomy. Survival was analyzed by Kaplan-Meier survivor functions, Cox proportional hazard models, and the log rank test.
Twelve patients (six men and six women) with adenocarcinoma underwent pancreatectomy with resection of a tumor-involved HA (n = 2) and/or CA (n = 10). Median age at diagnosis was 62 years (range, 53–73 years). All patients completed neoadjuvant chemoradiotherapy with or without full dose chemotherapy before resection. Procedures performed were six extended pancreaticoduodenectomies, two proximal subtotal pancreatectomies, two distal pancreatectomies, and two total pancreatectomies. Ten cases involved celiac resections, and two had isolated HA resections. The 60-day mortality was 17% (2 of 12). Median survival after diagnosis was 20 months (range, 6–41 months). Median survival after resection was 17 months (range, 1–36 months). Survival was not statistically significantly related to age, sex, margin status, or preoperative CA19-9 level. The 3-year survival was 17%. There were no 5-year survivors.
Resection of the HA or CA with reconstruction may prolong survival for selected patients who undergo pancreatic resection after neoadjuvant therapy. However, this aggressive approach did not result in any long-term survivors in our series.
- Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236:355–66. CrossRef
- Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–49. CrossRef
- Ozaki H, Kinoshita T, Kosuge T, et al. An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas. Cancer 1996;77:2240–5. CrossRef
- Kimura W, Han I, Furukawa Y, et al. Appleby operation for carcinoma of the body and tail of the pancreas. Hepatogastroenterology 1997;44:387–93.
- Mayumi T, Nimura Y, Kamiya J, et al. Distal pancreatectomy with en bloc resection of the celiac artery for carcinoma of the body and tail of the pancreas. Int J Pancreatol 1997;22:15–21.
- Konishi M, Kinoshita T, Nakagori T, et al. Distal pancreatectomy with resection of the celiac axis and reconstruction of the hepatic artery for carcinoma of the body and tail of the pancreas. J Hepatobiliary Pancreat Surg 2000;7:183–7. CrossRef
- Kondo S, Katoh H, Hirano S, et al. Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbecks Arch Surg 2003;388:101–6. CrossRef
- Liu B. Modified Appleby operation in treatment of distal pancreatic cancer. Hepatobiliary Pancreat Dis Int 2003;2:622–5.
- Yamaguchi K, Nakano K, Kobayashi K, et al. Appleby operation for pancreatic body-tail carcinoma: report of three cases. Surg Today 2003;33:873–8. CrossRef
- Lin CC, Chen CL, Cheng YF. Modified extended distal pancreatectomy for carcinoma of body and tail of pancreas. Hepatogastroenterology 2005;52:1090–1.
- Makary MA, Fishman EK, Cameron JL. Resection of the celiac axis for invasive pancreatic cancer. J Gastrointest Surg 2005;9:503–7. CrossRef
- Gagandeep S, Artinyan A, Jabbour N, et al. Extended pancreatectomy with resection of the celiac axis: the modified Appleby operation. Am J Surg 2006;192:330–5. CrossRef
- Hishinuma S, Ogata Y, Tomikawa M, et al. Stomach-preserving distal pancreatectomy with combined resection of the celiac artery: radical procedure for locally advanced cancer of the pancreatic body. J Gastrointest Surg 2007;11:743–9. CrossRef
- Nakao A, Takeda S, Inoue S, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30:976–82. CrossRef
- Fortner JG. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg 1984;199:418–25. CrossRef
- Pingpank JF, Hoffman JP, Ross EA, et al. Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg 2001;5:121–30. CrossRef
- Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer 1953;6:704–7. CrossRef
- Kim HJ, Czischke K, Brennan MF, et al. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? J Gastrointest Surg 2002;6:763–9. CrossRef
- Howard TJ, Krug JE, Yu J, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 2006;10:1338–45. CrossRef
- Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567–79. CrossRef
- Neoptolemos JP, Stocken DD, Dunn JA, et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–68. CrossRef
- Survival After Pancreatectomy With Major Arterial Resection and Reconstruction
Annals of Surgical Oncology
Volume 15, Issue 5 , pp 1399-1406
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Extended pancreatectomy
- Locally advanced pancreatic cancer
- Industry Sectors
- Author Affiliations
- 1. Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
- 2. Vascular Surgery, Temple University, 3401N. Broad Street, Parkinson Pavillion, Suite 400, Philadelphia, PA, 19140, USA
- 3. Carolina Vascular Surgery, 2800 Blue Ridge Road, suite 500, Raleigh, NC, 27607, USA
- 4. Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- 5. Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania