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.
Pancreatoduodenectomy With Arterial Resection for Locally Advanced Pancreatic Cancer of the Head
Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients, and pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.
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.


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.
Survival After Pancreatectomy With Major Arterial Resection and Reconstruction
Resection of the HA or CA with reconstruction may prolong survival for selected patients who undergo pancreatic resection after neoadjuvant therapy, however, this aggressive approach did not result in any long-term survivors in this series.
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.
Vascular Resection in Pancreatic Cancer Surgery: Survival Determinants
Resection of the superior mesenteric or portal vein to achieve macroscopic tumor clearance can be performed safely with acceptable operative morbidity and mortality, however, improved local clearance in these patients cannot achieve a favorable long-term survival for all patients.
Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Body Cancer: Long-term Results
DP-CAR offers a high R0 resectability rate and may potentially achieve complete local control in selected patients and may indicate DP-CAR for the treatment of less advanced disease.
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.