OBJECTIVE BACKGROUND Combined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR). METHODS Retrospective review (2011-2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological data, perioperative therapy, time to recurrence (TTR), and overall survival (OS) were evaluated. RESULTS Initial staging revealed 533 resectable, 98 borderline, and 84 locally advanced PDAC cases. Pancreaticoduodenectomy was the most common procedure (n=467). NVR was performed in 351 (58.2%) patients, VR in 181 (30.0%), and AR in 70 (11.8%). The median TTR and OS did not significantly differ according to the initial staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 mo) compared to NVR (18.6 and 30.5 mo, P<0.001) and AR (20.6 and 30.9 mo, P=0.004 and P=0.017). Chemotherapy or chemoradiation significantly prolonged TTR (20.1 vs. 10.2 mo, P<0.001 and 25.3 vs. 16.4 mo, P<0.001) and OS (31.5 vs. 17.2 mo, P<0.001 and 35.5 vs. 27.5 mo, P=0.030). AR was associated with higher 90-day mortality rates. In the multivariable analysis, vascular resection was not associated with OS. Perioperative therapy, pathological N0 status, and absence of perineural invasion were the key predictors of longer TTR and OS. CONCLUSIONS Pancreatectomy with AR was not associated with worse oncological outcomes when controlling for perioperative therapy. However, AR was associated with higher 90-day mortality rates. Patient selection is crucial when performing AR in patients with PDAC.

中文翻译：

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胰腺癌的血管切除术 - 来自单个高容量中心的 10 年经验。


客观背景 胰腺导管腺癌 （PDAC） 越来越多地进行胰腺和血管联合切除术。我们评估了胰腺切除术非血管切除术 （NVR） 、静脉切除术 （VR） 和动脉切除术 （AR） 后的结局。方法 回顾性评价 （2011-2023） 接受根治性手术治疗的 715 例 PDAC 患者。评估临床病理资料、围手术期治疗、复发时间 （TTR） 和总生存期 （OS） 之间的关联。结果 初步分期显示 533 例可切除病例、98 例临界病例和 84 例局部晚期 PDAC 病例。胰十二指肠切除术是最常见的手术 （n=467）。351 例 （58.2%） 患者进行了 NVR，181 例 （30.0%） 进行了 VR，70 例 （11.8%） 进行了 AR。中位 TTR 和 OS 根据胰腺切除的初始分期或类型没有显著差异。与 NVR （18.6 和 30.5 mo，P<0.001） 和 AR （20.6 和 30.9 mo，P = 0.004 和 P=0.017） 相比，VR （14.5 和 22.7 mo） 的中位 TTR 和 OS 显著缩短。化疗或放化疗显著延长了 TTR （20.1 vs. 10.2 mo，P<0.001 和 25.3 vs. 16.4 mo，P<0.001）和 OS （31.5 vs. 17.2 mo，P<0.001 和 35.5 vs. 27.5 mo，P=0.030）。AR 与较高的 90 天死亡率相关。在多变量分析中，血管切除与 OS 无关。围手术期治疗、病理 N0 状态和无神经周围浸润是较长 TTR 和 OS 的关键预测因子。结论 在控制围手术期治疗时，胰腺切除术伴 AR 与较差的肿瘤学结果无关。然而，AR 与较高的 90 天死亡率相关。对 PDAC 患者进行 AR 时，患者选择至关重要。