Pancreatectomy With Arterial Resection for Pancreatic Adenocarcinoma: How Can It Be Done Safely and With Which Outcomes?: A Single Institution's Experience With 118 Patients.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
pubmed:
7
9
2018
medline:
24
6
2020
entrez:
7
9
2018
Statut:
ppublish
Résumé
This study assesses the safety and outcomes of the largest cohort of pancreatectomy with arterial resection (P-AR). A high postoperative mortality rate and uncertain oncologic benefits have limited the use of P-AR for locally advanced pancreatic adenocarcinoma. We retrospectively reviewed a prospectively maintained database of patients who underwent P-AR between January 1990 and November 2017. Univariate and multivariate Cox analyses were used to assess prognostic factors for survival. There were 118 consecutive resections (51 pancreaticoduodenectomies, 18 total pancreatectomies, and 49 distal splenopancreatectomies). Resected arterial segments included the coeliac trunk (50), hepatic artery (29), superior mesenteric artery (35), and other segments (4). The overall mortality and morbidity were 5.1% and 41.5%, respectively. There were 84 (75.4%) patients who received neoadjuvant chemotherapy, 105 (89%) simultaneous venous resections, and 101 (85.5%) arterial reconstructions. The rates of R0 resection and pathologic invasion of venous and arterial walls were 52.4%, 74.2%, and 58%, respectively. The overall survival was 59%, 13%, and 11.8% at 1, 3, and 5 years, respectively. The median overall survival after resection was 13.70 months (CI 95%:11-18.5 mo). In multivariate analysis, R0 resection (HR: 0.60; 95% CI: 0.38-0.96; P = 0.01) and venous invasion (HR: 1.67; 95% CI: 1.01-2.63; P = 0.04) were independent prognostic factors. In a specialized setting, P-AR for locally advanced pancreatic adenocarcinoma can be performed safely with limited mortality and morbidity. Negative resection margin and the absence of associated venous invasion might predict favorable long-term outcomes.
Sections du résumé
OBJECTIVE
This study assesses the safety and outcomes of the largest cohort of pancreatectomy with arterial resection (P-AR).
BACKGROUND
A high postoperative mortality rate and uncertain oncologic benefits have limited the use of P-AR for locally advanced pancreatic adenocarcinoma.
METHODS
We retrospectively reviewed a prospectively maintained database of patients who underwent P-AR between January 1990 and November 2017. Univariate and multivariate Cox analyses were used to assess prognostic factors for survival.
RESULTS
There were 118 consecutive resections (51 pancreaticoduodenectomies, 18 total pancreatectomies, and 49 distal splenopancreatectomies). Resected arterial segments included the coeliac trunk (50), hepatic artery (29), superior mesenteric artery (35), and other segments (4). The overall mortality and morbidity were 5.1% and 41.5%, respectively. There were 84 (75.4%) patients who received neoadjuvant chemotherapy, 105 (89%) simultaneous venous resections, and 101 (85.5%) arterial reconstructions. The rates of R0 resection and pathologic invasion of venous and arterial walls were 52.4%, 74.2%, and 58%, respectively. The overall survival was 59%, 13%, and 11.8% at 1, 3, and 5 years, respectively. The median overall survival after resection was 13.70 months (CI 95%:11-18.5 mo). In multivariate analysis, R0 resection (HR: 0.60; 95% CI: 0.38-0.96; P = 0.01) and venous invasion (HR: 1.67; 95% CI: 1.01-2.63; P = 0.04) were independent prognostic factors.
CONCLUSION
In a specialized setting, P-AR for locally advanced pancreatic adenocarcinoma can be performed safely with limited mortality and morbidity. Negative resection margin and the absence of associated venous invasion might predict favorable long-term outcomes.
Identifiants
pubmed: 30188399
doi: 10.1097/SLA.0000000000003010
pii: 00000658-202005000-00022
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
932-940Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Références
Katz MH, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 2008; 206:833–846.
Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006; 13:1035–1046.
Evans DB, Farnell MB, Lillemoe KD, et al. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 2009; 16:1736–1744.
Chauffert B, Mornex F, Bonnetain F, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 2008; 19:1592–1599.
Fortner JG, Kim DK, Cubilla A, et al. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg 1977; 186:42–50.
Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 1989; 124:127–132.
Petrelli F, Coinu A, Borgonovo K, et al. FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: a meta-analytical review of published studies. Pancreas 2015; 44:515–521.
Rombouts SJ, Walma MS, Vogel JA, et al. Systematic review of resection rates and clinical outcomes after FOLFIRINOX-based treatment in patients with locally advanced pancreatic cancer. Ann Surg Oncol 2016; 23:4352–4360.
Hackert T, Sachsenmaier M, Hinz U, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with Folfirinox results in resectability in 60% of the patients. Ann Surg 2016; 264:457–463.
Suker M, Beumer BR, Sadot E, et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 2016; 17:801–810.
Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 2014; 101:1000–1005.
de Wilde RF, Besselink MG, van der Tweel I, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 2012; 99:404–410.
Delpero JR, Boher JM, Sauvanet A, et al. Pancreatic adenocarcinoma with venous involvement: is up-front synchronous portal-superior mesenteric vein resection still justified? A survey of the Association Francaise de Chirurgie. Ann Surg Oncol 2015; 22:1874–1883.
Murakami Y, Satoi S, Motoi F, et al. Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg 2015; 102:837–846.
Hirano S, Kondo S, Hara T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg 2007; 246:46–51.
Hishinuma S, Ogata Y, Tomikawa M, et al. Stomach-preserving distal pancreatectomy with combined resection of the celiac artery: radical procedure for locally advanced cancer of the pancreatic body. J Gastrointest Surg 2007; 11:743–749.
Allendorf JD, Lauerman M, Bill A, et al. Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointest Surg 2008; 12:91–100.
Stitzenberg KB, Watson JC, Roberts A, et al. Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 2008; 15:1399–1406.
Wang C, Wu H, Xiong J, et al. Pancreaticoduodenectomy with vascular resection for local advanced pancreatic head cancer: a single center retrospective study. J Gastrointest Surg 2008; 12:2183–2190.
Amano H, Miura F, Toyota N, et al. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg 2009; 16:850–857.
Boggi U, Del Chiaro M, Croce C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 2009; 146:869–881.
Hartwig W, Hackert T, Hinz U, et al. Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 2009; 250:81–87.
Martin RC 2nd, Scoggins CR, Egnatashvili V, et al. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg 2009; 144:154–159.
Sugiura Y, Horio T, Aiko S, et al. Pancreatectomy for pancreatic cancer with reference to combined resection of the vessels, twenty nine year experience by a single surgeon. Keio J Med 2009; 58:103–109.
Ouaissi M, Hubert C, Verhelst R, et al. Vascular reconstruction during pancreatoduodenectomy for ductal adenocarcinoma of the pancreas improves resectability but does not achieve cure. World J Surg 2010; 34:2648–2661.
Sperti C, Berselli M, Pedrazzoli S. Distal pancreatectomy for body-tail pancreatic cancer: is there a role for celiac axis resection? Pancreatology 2010; 10:491–498.
Wu X, Tao R, Lei R, et al. Distal pancreatectomy combined with celiac axis resection in treatment of carcinoma of the body/tail of the pancreas: a single-center experience. Ann Surg Oncol 2010; 17:1359–1366.
Bachellier P, Rosso E, Lucescu I, et al. Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol 2011; 103:75–84.
Bockhorn M, Burdelski C, Bogoevski D, et al. Arterial en bloc resection for pancreatic carcinoma. Br J Surg 2011; 98:86–92.
Mollberg N, Rahbari NN, Koch M, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 2011; 254:882–893.
Yamamoto Y, Sakamoto Y, Ban D, et al. Is celiac axis resection justified for T4 pancreatic body cancer? Surgery 2012; 151:61–69.
Christians KK, Pilgrim CH, Tsai S, et al. Arterial resection at the time of pancreatectomy for cancer. Surgery 2014; 155:919–926.
Amano R, Kimura K, Nakata B, et al. Pancreatectomy with major arterial resection after neoadjuvant chemoradiotherapy gemcitabine and S-1 and concurrent radiotherapy for locally advanced unresectable pancreatic cancer. Surgery 2015; 158:191–200.
Mittal A, de Reuver PR, Shanbhag S, et al. Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR): common hepatic arterial stump pressure should determine the need for arterial reconstruction. Surgery 2015; 157:811–817.
Addeo P, Rosso E, Fuchshuber P, et al. Resection of borderline resectable and locally advanced pancreatic adenocarcinomas after neoadjuvant chemotherapy. Oncology 2015; 89:37–46.
Westermark S, Rangelova E, Ansorge C, et al. Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy. Langenbecks Arch Surg 2016; 401:1241–1247.
Hartwig W, Gluth A, Hinz U, et al. Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 2016; 103:1683–1694.
Glebova NO, Hicks CW, Tosoian JJ, et al. Outcomes of arterial resection during pancreatectomy for tumor. J Vasc Surg 2016; 63:722.e1–729.e1.
Wu G, Wang X, Zhao Q, et al. Intestinal autotransplantation for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery. Langenbecks Arch Surg 2016; 401:1249–1257.
Addeo P, Velten M, Averous G, et al. Prognostic value of venous invasion in resected T3 pancreatic adenocarcinoma: depth of invasion matters. Surgery 2017; 162:264–274.
Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 2015; 261:12–17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017; 161:584–591.
Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761–768.
Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142:20–25.
Delpero JR, Bachellier P, Regenet N, et al. Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens. HPB (Oxford) 2014; 16:20–33.
Bachellier P, Rosso E, Fuchshuber P, et al. Use of a temporary intraoperative mesentericoportal shunt for pancreatic resection for locally advanced pancreatic cancer with portal vein occlusion and portal hypertension. Surgery 2014; 155:449–456.
Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 2017; 43:358–363.
Fukuda S, Oussoultzoglou E, Bachellier P, et al. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg 2007; 142:172–179.
Oussoultzoglou E, Bachellier P, Bigourdan JM, et al. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004; 139:327–335.
Rosso E, Bachellier P, Oussoultzoglou E, et al. Toward zero pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. Am J Surg 2006; 191:726–732.
Rosso E, Lopez P, Roedlisch MN, et al. Double omental flap reduced perianastomotic collections and relaparotomy rates after pancreaticoduodenectomy with pancreaticogastrostomy. World J Surg 2012; 36:1672–1678.
Nimptsch U, Krautz C, Weber GF, et al. Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 2016; 264:1082–1090.
Farges O, Bendersky N, Truant S, et al. The theory and practice of pancreatic surgery in France. Ann Surg 2017; 266:797–804.
Perinel J, Nappo G, El Bechwaty M, et al. Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement. Langenbecks Arch Surg 2016; 401:1131–1142.
Hartwig W, Gluth A, Hinz U, et al. Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg 2015; 261:537–546.
Nakao A, Nonami T, Harada A, et al. Portal vein resection with a new antithrombogenic catheter. Surgery 1990; 108:913–918.
Nakao A, Takagi H. Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepatogastroenterology 1993; 40:426–429.
Jegatheeswaran S, Baltatzis M, Jamdar S, et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford) 2017; 19:483–490.
Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant 2015; 15:17–38.
Gong H, Ma R, Gong J, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer: a systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e3061.
Kondo S, Katoh H, Shimizu T, et al. Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepatogastroenterology 2000; 47:1447–1449.
Klompmaker S, van Hilst J, Gerritsen SL, et al. Outcomes after distal pancreatectomy with celiac axis resection for pancreatic cancer: a pan-european retrospective cohort study. Ann Surg Oncol 2018; 25:1440–1447.
Hammel P, Huguet F, van Laethem JL, et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the lap07 randomized clinical trial. JAMA 2016; 315:1844–1853.
Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017; 389:1011–1024.
Pietrasz D, Marthey L, Wagner M, et al. Pathologic major response after FOLFIRINOX is prognostic for patients secondary resected for borderline or locally advanced pancreatic adenocarcinoma: an AGEO-FRENCH, prospective, multicentric cohort. Ann Surg Oncol 2015; 22: (suppl 3): S1196–S1205.
Wang J, Estrella JS, Peng L, et al. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 2012; 118:3801–3811.