Arterial resection in pancreatic cancer surgery

• Verfasst von: Loos, Martin [VerfasserIn]
• Verfasst von: Kester, Tobias [VerfasserIn]
• Verfasst von: Klaiber, Ulla [VerfasserIn]
• Verfasst von: Mihaljevic, André Leopold [VerfasserIn]
• Verfasst von: Mehrabi, Arianeb [VerfasserIn]
• Verfasst von: Müller, Beat P. [VerfasserIn]
• Verfasst von: Diener, Markus K. [VerfasserIn]
• Verfasst von: Schneider, Martin [VerfasserIn]
• Verfasst von: Berchtold, Christoph [VerfasserIn]
• Verfasst von: Hinz, Ulf [VerfasserIn]
• Verfasst von: Feißt, Manuel [VerfasserIn]
• Verfasst von: Strobel, Oliver [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Titel: Arterial resection in pancreatic cancer surgery
• Titelzusatz: effective after a learning curve
• Verf.angabe: Martin Loos, MD, Tobias Kester, Ulla Klaiber, MD, Andre L. Mihaljevic, MD, MSc, Arianeb Mehrabi, MD, Beat M. Müller-Stich, MD, Markus K. Diener, MD, Martin A. Schneider, MD, Christoph Berchtold, MD, Ulf Hinz, MSc, Manuel Feisst, MSc, Oliver Strobel, MD, Thilo Hackert, MD, and Markus W. Büchler, MD
• Jahr: 2022
• Umfang: 10 S.
• Fussnoten: Date: Jun 12, 2020 ; Gesehen am 01.04.2022
• Titel Quelle: Enthalten in: Annals of surgery
• Ort Quelle: [Erscheinungsort nicht ermittelbar] : Lippincott Williams & Wilkins, 1885
• Jahr Quelle: 2022
• Band/Heft Quelle: 275(2022), 4, Seite 759-768
• ISSN Quelle: 1528-1140
• DOI: doi:10.1097/SLA.0000000000004054
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1797309757

Abstract

Objective: - To investigate the perioperative and oncologic long-term outcomes of patients with LAPC after surgical resection at a high-volume center for pancreatic surgery. - Background: - The role of surgery in LAPC with arterial involvement is controversial. - Methods: - We analyzed 385 consecutive patients undergoing PAR (n = 195) or PAD (n = 190) of the encased artery for LAPC between January 1, 2003 and April 30, 2019. - Results: - There were 183 total pancreatectomies, 113 partial pancreatoduodenectomies, 79 distal pancreatectomies, and 10 resections for tumor recurrences, including 121 multivisceral resections and 171 venous resections. Forty-three patients (11.4%) had resectable oligometastatic disease. All of the 190 patients undergoing PAD (100%) and 95 of the 195 patients undergoing PAR (48.7%) received neoadjuvant chemotherapy. The R0 (circumferential resection margin negative) resection rate was 28%. The median hospital stay was 15 days (range: 3-236). The median survival after surgery for LAPC was 20.1 months and the overall 5-year survival rate 12.5%. In-hospital mortality was 8.8% for the entire patient cohort (n = 385). With increasing case load and growing expertise, there was a significant reduction of in-hospital mortality to 4.8% (n = 186) after 2013 (P = 0.005). The learning curve of experienced pancreatic surgeons for PAR was 15 such procedures. - Conclusion: - Our data demonstrate that an arterial surgical approach is effective in LAPC with promising long-term survival. PAD after neoadjuvant treatment is safe. PAR is a technically demanding procedure and requires a high level of expertise.