Arterial Resection During Pancreatectomy for Pancreatic Cancer: A Systematic Review and Meta-Analysis

  title={Arterial Resection During Pancreatectomy for Pancreatic Cancer: A Systematic Review and Meta-Analysis},
  author={Nathan M. Mollberg and Nuh N. Rahbari and Moritz Koch and Werner Hartwig and Yumiko E. Hoeger and Markus W. B{\"u}chler and J{\"u}rgen Weitz},
  journal={Annals of Surgery},
Background:The majority of pancreatic cancers are diagnosed at an advanced stage. As surgical resection remains the only hope for cure, more aggressive surgical approaches have been advocated to increase resection rates. Institutions have begun to release data on their experience with pancreatectomy and simultaneous arterial resection (AR), which has traditionally been considered a general contraindication to resection. The aim of the present meta-analysis was to evaluate the perioperative and… 

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

Arterial Resection in Pancreatic Cancer Surgery

The data demonstrate that an arterial surgical approach is effective in LAPC with promising long-term survival and PAD after neoadjuvant treatment is safe.

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

Celiac axis involvement should no longer be considered a strict contraindication to surgery in patients with locally advanced pancreatic adenocarcinoma and DP-CAR was not associated with higher mortality compared to standard DP; however, overall morbidity was higher.

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

The important features in surgery for pancreatic cancer and specifically to arterial resections are outlined and compared to the published literature on venous resections, and the limitations associated with analysing results from heterogenous data are discussed.

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

A survival benefit of neoadjuvant chemotherapy was identified, compared to upfront surgery, and pancreatectomy with AR for advanced pancreatic cancer showed acceptable procedure-related morbidity and mortality.

Perioperative and long-term outcome of en-bloc arterial resection in pancreatic surgery.

Pancreatectomy Combined with Arterial Resection for Pancreatic Carcinoma with Arterial Infiltration: A Meta-analysis

It is concluded that pancreatectomy with AR could be conducted under the comprehensive consideration of patients’ conditions, and it may be especially beneficial for those who have the probability to achieve R0 resection.

Do arterial resections improve survival in pancreatic cancer?-A narrative review.

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.

Arterial resection at the time of pancreatectomy for cancer.

Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma?

Extended pancreatectomy operations should be limited to specialist units with great experience in pancreatic surgery as well as experience in peri- and post-operative management of patients with pancreatic diseases due to the higher morbidity and mortality rates.



Multivisceral Resection for Pancreatic Malignancies: Risk-Analysis and Long-Term Outcome

Multivisceral resections can be performed with increased morbidity but comparable mortality and long-term prognosis as compared with standard pancreatic resections at high volume centers.

Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes.

En bloc vascular resection consisting of venous resection alone, arterial resections alone, or combined vascular resections at the time of pancreatectomy for adenocarcinoma did not adversely affect postoperative mortality, morbidity, or overall survival.

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

DP-CAR improves resectability without increasing the mortality rate, and should be considered for the inclusion among the ‘extended’ procedures for the treatment of body-tail pancreatic cancers invading the celiac axis.

Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?

It is thought that resection is useful only when surgery of R0 has taken place for selected locally advanced pancreatic cancer (M0), and decisions on operative indications should be not be made slightly.

Indications and Techniques of Extended Resection for Pancreatic Cancer

The most important indication for vascular resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins, otherwise, vascular resections is contraindicated.

Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection.

Eighteen patients are reported who have had a regional pancreatectomy, which has doubled the resectability rate in this institution and the quality of life was good for most patients.

Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group.

The addition of an extended lymphadenectomy and retroperitoneal soft-tissue clearance to a pancreatoduodenal resection does not significantly increase morbidity and mortality rates, and overall survival does not differ between the two groups.

Extended resections of ductal pancreatic cancer--impact on operative risk and prognosis.

114 patients received a standard and 75 patients an extended resection of ductal pancreatic carcinoma at the Hanover Medical School, Germany, from 1971 until 1993, where resections of synchronous hepatic metastases and colectomies were associated with a poor survival probability.

[Indication and results of pancreatectomy with combined resection of vessels for adenocarcinoma of the pancreas].

Of 192 patients who received pancreatectomy for invasive adenocarcinoma of the pancreas, 107 (55.7%) underwent combined resection of vessels at Keio University Hospital and Tochigi Cancer Center, from July 1974 until March 1996, there are no significant difference in the morbidity and mortality rates.

Distal Pancreatectomy With En Bloc Resection of the Celiac Trunk for Extended Pancreatic Tumor Disease: An Interdisciplinary Approach

Initial experiences in a small series of patients with left celiacopancreatectomy with or without angiographic preconditioning of arterial blood flow to the stomach and the liver are described, finding that ischemic complications after celiacanxiety occurred only in those patients who did not receive preoperative celiac trunk embolization.