Arterial resections in pancreatic cancer – Systematic review and meta-analysis

Małczak, Piotr; Sierżęga, Marek; Stefura, Tomasz; Kacprzyk, Artur; Droś, Jakub; Skomarovska, Oksana; Krzysztofik, Marta; Major, Piotr; Pędziwiatr, Michał

doi:10.1016/j.hpb.2020.04.005

Cited by 34 publications

(27 citation statements)

References 47 publications

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“…In our series, a patient who underwent sub-adventitial divestment developed a hepatic artery pseudoaneurysm whose bleeding was controlled by interventional radiology. Nevertheless, studies have shown that the divestment technique is safe and without excessive mortality, especially when compared to arterial resection and reconstruction [ 16 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Arterial Divestment and Resection in Post-neoadjuvant Pancreatic Adenocarcinoma

Limbu¹,

Regmee²,

Ghimire³

et al. 2021

Cureus

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Introduction The advent of neoadjuvant therapy in the management of pancreatic adenocarcinoma has significantly improved the prognosis of the disease. Nevertheless, the only chance of long-term disease-free survival in pancreatic cancer is achieved with complete tumor resection, and artery involvement by the tumor is one of the major determinants in its resectability. We aim to evaluate the feasibility of a novel technique, namely, the periarterial divestment, which has allowed surgeons to clear the tumor tissues off the visceral arteries without the need for arterial reconstruction. Materials and methods In this single-center, retrospective, descriptive, cross-sectional study done between August 2019 and July 2021, seven consecutive patients with histologically confirmed pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant therapy were included. Arterial divestment was performed in six of seven patients and arterial reconstruction was performed in one of the patients. The data on perioperative and the early oncological outcome were recorded. Results Five patients underwent periarterial divestment, one underwent sub-adventitial divestment, and one underwent superior mesenteric artery reconstruction due to deeper tumor infiltration into the arterial wall. The intraoperative frozen section of periarterial tissue was positive in three cases and the final histopathological specimen after the divestment showed a positive margin in two of the cases. The clinically significant postoperative pancreatic fistula was noted in two patients, and one patient experienced grade C post-pancreaticoduodenectomy hemorrhage due to a hepatic artery pseudoaneurysm. Four patients, all of whom underwent periarterial divestment, experienced postoperative diarrhea. There were no mortality and the median postoperative hospital stay was seven days. Conclusion The need for arterial reconstruction in borderline and locally advanced pancreatic cancer can be avoided by using the periarterial divestment technique. Divestment of arteries is technically feasible and can be carried out safely without compromising the patient's oncological outcome. However, further validation of this technique must be done by well-designed studies with a greater sample size.

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Section: Discussionmentioning

confidence: 99%

Arterial Divestment and Resection in Post-neoadjuvant Pancreatic Adenocarcinoma

Limbu¹,

Regmee²,

Ghimire³

et al. 2021

Cureus

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“…However, almost all surgeons in this study would declare a tumour unresectable intraoperatively if arterial involvement were identified, particularly of the superior mesenteric artery. Arterial resection and reconstruction in PDAC have been previously reported in very selective cases ( 43 ), but is characterised by high rates of postoperative complications and questionable survival benefit ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice

et al. 2021

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BackgroundIt is presently unclear what clinical pathways are followed for patients with non-metastatic PDAC in specialised centres for pancreatic surgery across the United Kingdom (UK).MethodsBetween August 2019 and August 2020 an electronic survey was conducted aiming at a national cohort of pancreatic surgeons in the UK. Participants replied to a list of standardised questions and clinical vignettes, and data were collected and analysed focusing on management preferences, resectability criteria, and contraindications to surgery.ResultsWithin the study period, 65 pancreatic surgeons from 27 specialist centres in the UK (96%) completed the survey. Multidisciplinary team meetings are utilised universally for the management of patients with PDAC, however, different staging systems for resectability classification are being applied. In borderline resectable PDAC, most surgeons were keen to proceed with surgical exploration post NAT, but differences were noted in preferred chemotherapy regimens. Surgeons from standard volume institutions performed fewer vein resections annually and were more likely to deem patients with locally advanced PDAC as unresectable. Intra-institutional variability in patient management was also present and ranging between 20-80%.ConclusionsSignificant variability in the surgical management of non-metastatic PDAC was identified both on inter- and intra-institutional level.

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“…This literature review will provide an overview on current evidence regarding the staging and risk assessment of pancreatic cancer with arterial invasion, possible treatment options and their technical details, and their effect on relevant outcomes. We present the following article in accordance with the Narrative Review reporting checklist (available at https://dx.doi.org/10.21037/cco- [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39].…”

Section: Introductionmentioning

confidence: 99%

“…In another meta-analysis from 2020, 19 studies were included in an analysis involving 2,710 patients. Arterial resection was associated with a higher risk of death (RR: 4.09; P<0.001) and morbidity (RR: 1.4; P=0.01) and a shorter long-term survival (39). Also in 2020, Haines et al performed a metaanalysis of 13 studies with 467 patients who underwent pancreatic surgery with arterial resection for pancreatic cancer.…”

mentioning

confidence: 99%

Do arterial resections improve survival in pancreatic cancer?—a narrative review

Rebelo¹,

Ronellenfitsch²,

Döbereiner³

et al. 2021

Chin Clin Oncol

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In this article, we outline the important features of pancreatic cancer surgery in cases with visceral artery encasement.Background: Despite recent advances in diagnosis and treatment, pancreatic cancer continues to have a poor prognosis. Due to its limited response to chemotherapies, radiation, or targeted therapies, surgery (in combination with adjuvant chemotherapy) is the only potential way to treat pancreatic cancer in a curative manner. As only about 20% of the patients have surgically resectable disease at the time of diagnosis, the resection of encased visceral veins and arteries, along with neoadjuvant regimens, is one approach to treat otherwise palliative patients.Methods: Based on a selective literature review, we discuss the results of several studies and meta-analyses, comparing the mortality and morbidity, as well as long-term survival in patients undergoing arterial resection vs standard treatment. We conducted a selective literature review in PubMed without restrictions regarding time of publication or study design. Only articles in English language were selected.Conclusions: Several studies and meta-analyses comparing resection with and without arterial resection and reconstruction showed a significantly higher post-operative mortality and morbidity and shorter long-term survival in patients who required arterial resection. In patients with tumors initially considered irresectable, the approach of neoadjuvant chemotherapy followed by resection with arterial reconstruction showed a significantly increased survival compared to palliative chemotherapy alone with acceptable postoperative morbidity. Tumor resection with arterial reconstruction following intensive preoperative chemotherapy (plus radiochemotherapy in some cases) should be considered in selected patients, as it can prolong survival and potentially lead to sustained freedom from tumor recurrence.

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Arterial resections in pancreatic cancer – Systematic review and meta-analysis

Cited by 34 publications

References 47 publications

Arterial Divestment and Resection in Post-neoadjuvant Pancreatic Adenocarcinoma

Arterial Divestment and Resection in Post-neoadjuvant Pancreatic Adenocarcinoma

Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice

Do arterial resections improve survival in pancreatic cancer?—a narrative review

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