NOVEL APPROACH FOR LOCALLY ADVANCED PANCREATIC CANCER SURGERY: ARTERIAL RESECTION AND RECONSTRUCTION FIRST, R0-PANCREATECTOMY AND VEIN RESECTION SECOND. EXPERIENCE OF 106 ARTERIAL RESECTIONS
Viacheslav Egorov*, Soslan Dzigasov, Pavel Kim, Alex Kolygin, Viborny Mikhail, Grigory Bolshakov
Il'inskaa bol'nica, Moskva, Moskva, Russian Federation
Background. Modern results of neoadjuvant therapy have justified arterial resections for locally advanced pancreatic ductal adenocarcinoma(LA-PDAC). Restricted space, excess of "fixation points" and significant duration of arterial and portal clamping are challenging conditions as for R0-pancreatectomy, so as for prevention of liver or intestinal ischemia in resections of the SMA or hepatic arteries with PV/SMV. Approach "Arterial Resection and Reconstruction first, Ro-pancreatectomy and Vein Resection second", 1.artRR+2.PR+VR, can be a response on this challenge in majority of cases. Due to untouched venous inflow, arterial resection and reconstruction is safer before mobilization of the pancreas because of collaterals usually sacrificed during mobilization.
Aim. To assess safety and efficacy of 1.artRR+2.PR+VR method for LA-PDAC surgery.
Method: Retrospective analysis of 106 arterial resections associated with pancreatectomies(2009-2022) in 84 consecutive pancreatectomies including 33 1.artRR+2.PR+VR .
Results: For 79 elective patients with 101 arterial resections (42 DPCARs, 28 TP, 9 PD) R0-resection rate was 92%, mortality - 6,8% (bleeding(3),Miocardial infarctionI(1),sepsis(1)), general and major morbidity – 56% and 24%, ischemic complications - 6,5%(n6), POPF B/C-13(24%). For PDAC(n56) median OS and PFS were 30 and 19 months, 5-y survival-31%, actual 5-y survival–19. For 33 artRR+(PR +VR) mean OP time was 745±145min, mean blood loss- 570±320ml, vein resection rate–88%, DGE – 29%, mortality 3%, major morbidity – 23.5%, with no ischemic complications. In all cases IOUS and ICG angiography were the technique for assessment of blood flow adequacy. All the relapses, except five, were distant.
Conclusion: 1.artRR+2.PR+VR is a reasonable approach for LA-PDAC, which increasing Ro- pancreatic and arterio-venous resection rate, minimizing liver and bowel ischemia
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