SSAT - Pancreatectomy With Arterial Resection and Reconstruction for Locally Advanced Pancreatic Cancer Involving Major Visceral Arteries (T4 lesions) Can Acheive R0 Resection With Improved Survival

Back to 2016 Annual Meeting

Pancreatectomy With Arterial Resection and Reconstruction for Locally Advanced Pancreatic Cancer Involving Major Visceral Arteries (T4 lesions) Can Acheive R0 Resection With Improved Survival
Yuri Genyk^*, Afsaneh Barzi, Joseph DiNorcia, Ara Sahakian, Syma Iqbal, James L. Buxbaum, Anthony El-Khoueiry, Jacques Van Dam, Heinz-Josef Lenz, robert r. selby
University of Southern California, Los Angeles, CA

Introduction: Locally advanced disease is found in about 40% of patients with pancreatic cancer at initial presentation. Patients with locally advanced pancreatic cancer (LAPC) involving major visceral arteries are generally considered unresectable and offered systemic therapy only, with a median overall survival (MOS) of approximately 11 months. In this study, we evaluated whether pancreatic resection combined with arterial resection and reconstruction for LAPC could acheive R0 resection and improve outcomes.
Methods: From December 2002 to November 2015, the following data were collected prospectively in patients with LAPC who underwent pancreatic resection with vascular resection and reconstruction: age, gender, operative details, post-operative complications, adjuvant therapy, and overall and disease-free survival. Survival was calculated using Kaplan-Meier survival probability estimates.
Results: Twenty patients with LAPC (10 males and 10 females, median age 67 years (range: 49-83 years)) underwent pancreatic resection with concomitant resection and reconstruction of major visceral arteries. Pancreatic resections included pancreatico-duodenectomy (n=13), distal pancreatectomy (n=5), and total pancreatectomy (n=2). Arterial resections included hepatic artery (n=3), celiac trunk (n=11) and superior mesenteric artery (n=6). Arterial reconstructions included resection of the celiac axis without reconstruction (n=5), reconstruction of one artery (n=9), two arteries (n=5), and three arteries (n=1). Fourteen of the 20 patients underwent simultaneous venous resection and reconstruction. R0 resection was acheived in 16 patients, R1 in 2, and R2 in 2 patients. Three patients with involvement of the hepatic artery were excluded from the analysis which was performed for remaining 17 patients with T4 lesions (Stage III). In this group, 1 patient (5%) died peri-operatively from pulmonary thromboembolism. Median hospital stay was 16 days (range: 7-53 days). Chemo- or chemo-radiation therapy was not protocolized, and 4 patients did not receive chemotherapy. The six-month survival was 75%. Median overall survival (MOS) and disease-free survival (DFS) were 17 and 8 months, respectively, in the whole group (Figure 1) and 22 and 15 months in patients who received chemotherapy (Figure 2).
Conclusions: Pancreatectomy with arterial resection and reconstruction for LAPC involving major visceral arteries is safe and feasible in carefully selected patients. A median overall survival of 22 months is encouraging and provides the opportunity to reconsider the contraindications to surgical management of patients with LAPC. The timing of perioperative chemotherapy will be evaluated in a prospective trial.

Fig 1. Kaplan-Meier survival of LAPC patients (whole group)

Fig 2. Kaplan-Meier survival of LAPC patients (received chemotherapy)

Back to 2016 Annual Meeting