Journal Article

Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series

Feo, Claudio F., Fancellu, Alessandro, Ninniri, Chiara, Ginesu, Giorgio C., Cherchi, Giuseppe, Crivelli, Paola, Porcu, Alberto, Deiana, Giulia

2021

Overview

Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis. Radical surgery is the best option for cure and, nowadays, it is performed by many surgeons also in cases of vascular infiltration. Whether this aggressive approach to a locally advanced PDAC produces a survival benefit is under debate. Most data in the literature come from retrospective comparative studies; therefore, it is still unclear if such an extensive surgery for an advanced cancer is justified. Methods A retrospective review of patients with PDAC treated at our institution over a 12-year period was performed. Data concerning patients’ characteristics, operative details, postoperative course, and long-term survival were retrieved from prospective databases and analysed. Factors associated with poor survival were assessed via Cox regression analysis. Results A total of 173 patients with PDAC were included in the analysis, 41 subjects underwent pancreatectomy with vascular resection for locally advanced disease, and in 132 patients, only a pancreatic resection was undertaken. Demographics, major comorbidities, and tumour characteristics were similar between the two groups. Length of surgery ( P =0.0006), intraoperative blood transfusions ( P <0.0001), and overall complications ( P <0.0001) were significantly higher in the vascular resection group. Length of hospital stay ( P =0.684) and 90-day mortality ( P =0.575) were comparable between groups. Overall median survival ( P = 0.717) and survival rates at 1, 3, and 5 years ( P =0.964, P =0.500, and P =0.445, respectively) did not differ significantly between groups. Age ≥70 years and postoperative complications were independent predictors of lower survival. Conclusions Our study confirms that pancreatectomy with vascular resection for a locally advanced PDAC is a complex operation associated with a significant longer operating time that may increase morbidity; however, in selected patients, R0 margins can be obtained with an acceptable long-term survival rate. Older patients are less likely to benefit from surgery.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adenocarcinoma / Adult / Aged / Aged, 80 and over / Arterial infiltration / Blood transfusion / Cancer / Carcinoma, Pancreatic Ductal - mortality / Carcinoma, Pancreatic Ductal - pathology / Carcinoma, Pancreatic Ductal - surgery / Care and treatment / Comparative studies / Complications / Demographics / Demography / Development and progression / Evaluation / Excision (Surgery) / Female / Hospitals / Humans / Lymphatic system / Male / Malignancy / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Methods / Middle Aged / Morbidity / Mortality / Neoplasm Metastasis / Pancreas / Pancreatectomy - methods / Pancreatectomy - mortality / Pancreatic cancer / Pancreatic ductal adenocarcinoma / Pancreatic Neoplasms - mortality / Pancreatic Neoplasms - pathology / Pancreatic Neoplasms - surgery / Pancreatic surgery / Patient outcomes / Patients / Postoperative Complications / Prognosis / Regression analysis / Retrospective Studies / Surgery / Surgical Oncology / Survival / Survival Analysis / Survival Rate / Survivors / Tumors / Veins & arteries / Venous infiltration