Vascular resection and reconstruction for pancreatic malignancy: A single center survival study

Introduction Pancreatic cancer is one of the leading causes of cancer-related death in the USA. Recently, several centers have introduced portal and superior mesenteric vein resection and reconstruction during extended pancreatectomy, rendering the previously inoperable cases resectable. Aim The aim of this study is to confirm whether patients with locally advanced pancreatic cancer and mesenteric vascular invasion can be cured with extended pancreatectomy with vascular reconstruction (VR) and to compare their survival to patients treated with pancreatectomy without VR and those treated without resection (palliation). Methods Survival of 22 patients who underwent pancreatectomy with VR was compared with two control groups: 54 patients who underwent pancreatectomy without the need for VR and 28 patients whose pre-operative imaging suggested resectability but whose laparotomy indicated inoperability. Results A slight survival benefit was noted in patients who did not require VR (33.5%) compared to those who did require VR [20%, p=0.18], although not reaching statistical significance. Despite a low 15% three-year survival in patients treated palliatively, this was not statistically different compared to survival after resection with VR (P=0.23). The presence of nodal metastasis was associated with worse survival (p=0.006), and the use of adjuvant therapy was associated with better survival (p=0.001). Conclusion Pancreatic cancers that require VR to completely resect the tumor have a similar survival to those not requiring VR. Long-term survival was achievable in approximately I out 5 patients requiring VR, although we were not able to demonstrate statistically improved survival compared to palliative care.