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Prognostic impact of abutment to the branches of the superior mesenteric artery in borderline resectable pancreatic cancer

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Abstract

Purpose

The clinical impact of abutment to an artery and its branch on resectability and prognosis in patients with borderline resectable pancreatic cancer is unclear.

Methods

Patients diagnosed with borderline resectable pancreatic cancer due to artery abutment between April 2012 and December 2018 were enrolled. Contact between arteries and the tumour was assessed by computed tomography (CT).

Results

A primary lesion was resected in 63 patients (R group) and unresected in 19 patients (UR group). Overall survival (OS) was worse in the UR group than in the R group (P < 0.001). Multivariate analysis showed that abutment to the superior mesenteric artery (SMA) branches (P = 0.001) was an independent predictor of poor OS after surgery. Regarding the initial recurrence pattern, abutment to the SMA branches was significantly associated with high incidence of distant metastasis (P < 0.001). According to the most distal SMA branch attached on CT, significant differences in RFS were found between absent–J1A (P = 0.017), J2A–J3A (P = 0.0313) and J3A–middle colic artery (MCA, P = 0.0476) but not between J1A–J2A (P = 0.8207). Significant prognostic differences in OS after initiation of the treatment were found between absent–J1A/J2A (P = 0.006) and J1A/J2A–J3A/MCA (P = 0.033) but not between J3A/MCA–UR (P = 0.494).

Conclusion

Abutment to the SMA branches was associated with high incidence of distant metastasis after resection and a poor survival. Especially, abutment to the J3A or MCA was associated with poor prognosis comparable with that of the UR group.

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Acknowledgements

We would like to thank Keita Mori, Statistician, whose statistical expertise was invaluable during the analysis and interpretation of the data.

Author information

Authors and Affiliations

  1. Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan

    Taisuke Imamura, Yusuke Yamamoto, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida, Katsuhisa Ohgi & Katsuhiko Uesaka

  2. Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Akiko Todaka & Akira Fukutomi

  3. Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Rui Sato & Takeshi Aramaki

Authors
  1. Taisuke Imamura
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  2. Yusuke Yamamoto
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  3. Teiichi Sugiura
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  4. Yukiyasu Okamura
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  5. Takaaki Ito
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Contributions

Study conception and design: TI and YY. Acquisition of data: TI and YY. Analysis and interpretation of data: TI, YY and TS. Drafting of manuscript: TI, YY and KU. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Yusuke Yamamoto.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional 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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Electronic supplementary material

Supplementary Table S1

shows the MDCT findings of the artery abutment in pre-NAT and post-NAT settings. Specifically, SMA abutment was classified into abutment of its branches and abutment of its main trunk. Abutment to the main trunk of the SMA was classified as absent, J1A level, J2A level, J3A level and J4A level according to the most distal site of contact. Abutment to the SMA branches was classified as absent, J1A, J2A, J3A and MCA according to the most distal jejunal artery or MCA attached on post-NAT CT. In pre-NAT CT, abutment of the main trunk of SMA was found in 41 patients (68%) and in post-NAT CT, abutment of the main trunk of SMA was found in 35 (58%). In pre-NAT CT, abutment of the branches of the SMA was found in 27 patients (45%) and in prost-NAT CT, abutment of the branches of the SMA was found in 24 (40%). Changes regarding abutment of the CA, hepatic artery, and replaced hepatic artery were not found. (DOCX 16 kb)

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Imamura, T., Yamamoto, Y., Sugiura, T. et al. Prognostic impact of abutment to the branches of the superior mesenteric artery in borderline resectable pancreatic cancer. Langenbecks Arch Surg 405, 939–947 (2020). https://doi.org/10.1007/s00423-020-01970-4

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