Novel implications of combined arterial resection for locally advanced pancreatic cancer in the era of newer chemo-regimens.

Abstract

INTRODUCTION\nIn this study, we assessed the prognostic efficacy and feasibility of combined arterial resection (AR) for locally advanced pancreatic cancer (LAPC), and aimed to identify significant prognostic factors for patients who underwent combined AR.\n\n\nMETHODS\nBetween 1981 and 2018, 733 consecutive patients who underwent pancreatic surgery for PC were identified. The 730 cases with detailed information were enrolled in the analysis.\n\n\nRESULTS\nAmong 730 resected PC patients, 44 (6%) underwent AR including 21 hepatic (48%), 12 celiac (27%), five splenic (12%), four superior mesenteric (9%), and two other arteries (4%). The combined AR surgery showed significantly longer operative time (median, 608 vs 451\u202fmin, P\u202f<\u202f0.0001), and the incidence of intraoperative blood transfusion was significantly higher in AR than surgery without AR (P\u202f=\u202f0.0002), whereas there was no significant difference in the intraoperative blood loss (970 vs 1200\u202fmL, P\u202f=\u202f0.2) and occurrence of major complications (P\u202f=\u202f0.5). In prognostic analysis of AR cases, multivariate Cox proportional hazard models revealed preoperative and postoperative therapy were the independent factors for both recurrence-free survival (RFS) and overall survival (OS) (preoperative therapy: RFS, HR\u202f=\u202f0.21, P\u202f=\u202f0.007; OS, HR\u202f=\u202f0.18, P\u202f=\u202f0.01; postoperative therapy: RFS, HR\u202f=\u202f0.31, P\u202f=\u202f0.003; OS, HR\u202f=\u202f0.19, P\u202f=\u202f0.002).\n\n\nCONCLUSION\nThis study showed the feasibility of combined AR for LAPC and robust association of pre- and postoperative therapy and survival after AR surgery. Preoperative therapy following combined AR surgery is potentially powerful strategy for LAPC.