Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Abstract

Objective Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery. Methods A systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed. Results Eight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8–43.1 months, p = 0.037). Conclusions Arterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.

Radical Resection for Locally Advanced Pancreatic Cancers in the Era of New Neoadjuvant Therapy—Arterial Resection, Arterial Divestment and Total Pancreatectomy

“…Recent reports have documented favorable short-term outcomes of venous resection in patients with localized PCs [ 10 , 11 ]; however, the R0 resection rate, as well as long-term survival, remained unsatisfactory, because the most frequent site of cancer-positive margin was located at the superior mesenteric artery (SMA) margin [ 12 , 13 ], which could not be overcome by venous resection alone. Therefore, the necessity of more radical dissection, including arterial resection, remained and has become more prominent in the past two decades, although recent meta-analyses concluded that pancreatectomy with ARs remained a challenge, because it increased the complexity of the procedure and was associated with increased morbidity and mortality in comparison to non-AR pancreatectomies [ 14 , 15 ].…”

Pancreaticoduodenectomy with vascular divestment for locally advanced pancreatic neuroendocrine tumour

“…A non‐tumour infiltrated plane is opened by blunt or sharp dissection and followed with a circumferential vascular dissection 7 . This approach allows avoiding arterial resection and reconstruction, which is associated with non‐negligible morbi‐mortality 8 in spite of no or limited survival advantage (in the setting of pancreatic carcinoma) 9 . The use of arterial divestment may have advantages over arterial resection also for pancreatic NETs.…”

Distal Pancreatectomy with Celiac Axis Resection: Systematic Review and Meta-Analysis

“…The first evidence in the literature for the CA resection without reconstruction was reported for a case of gastric cancer requiring total gastrectomy by Appleby in 1953 [ 24 ]. Nowadays, arterial resection of the CA has been translated to DP, in a procedure named DP-CAR [ 25 , 26 ]. This technique has been debated over the years due to its technical difficulty and its morbidity and mortality.…”