Outcomes of arterial resection during pancreatectomy for tumor

被引:21
作者
Glebova, Natalia O. [1 ,3 ]
Hicks, Caitlin W. [3 ]
Tosoian, Jeffrey J. [4 ]
Piazza, Kristen M. [3 ]
Abularrage, Christopher J. [3 ]
Schulick, Richard D. [2 ]
Wolfgang, Christopher L. [5 ]
Black, James H., III [3 ]
机构
[1] Univ Colorado Denver, Dept Surg, Sect Vasc Surg & Endovasc Therapy, Aurora, CO USA
[2] Univ Colorado Denver, Dept Surg, Div GI Tumor & Endocrine Surg, Aurora, CO USA
[3] Johns Hopkins Univ Hosp, Div Vasc Surg & Endovasc Therapy, Dept Surg, 600 N Wolfe St,Halsted 668, Baltimore, MD 21287 USA
[4] Johns Hopkins Univ Hosp, James Buchanan Brady Urol Inst, Dept Urol, Baltimore, MD 21287 USA
[5] Johns Hopkins Univ Hosp, Dept Surg, Div Surg Oncol, Baltimore, MD 21287 USA
关键词
CELIAC AXIS RESECTION; EN-BLOC RESECTION; DISTAL PANCREATECTOMY; VASCULAR RESECTION; RECONSTRUCTION; CANCER; PANCREATICODUODENECTOMY; SURGERY; SURVIVAL; BODY;
D O I
10.1016/j.jvs.2015.09.042
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Arterial resection (AR) during pancreatic tumor resection is controversial. We examined the safety and efficacy of AR during pancreatectomy. Methods: We used a prospective institutional database that includes 6522 patients who underwent pancreatectomy from 1970 to 2014; 35 had AR. We performed a 2:1 propensity match for patients without and with AR on the basis of preoperative patient and tumor variables. We then compared operative and postoperative outcomes between matched groups. Results: AR included 18 hepatic, 8 celiac, 3 splenic, 3 middle colic, 2 superior mesenteric, and 1 left renal artery. There were 20 primary, 4 vein, and 2 graft reconstructions; 11 were emergent and 24 elective. Before matching, patients with AR were younger (58 +/- 2 vs 63 +/- 0.2 years old; P = .05), more likely to be of black race (26% vs 9%; P = .003), to have received preoperative chemotherapy (17% vs 2%; P < .001), have a later stage and larger tumor (4 +/- 0.8 vs 3 +/- 0.04 cm; P = .05), more resections that included removal of all macroscopic disease, but microscopic residual tumor remained (31% vs 14%; P = .02), greater blood loss (1285 +/- 276 vs 822 +/- 16 mL; P = .02), and more frequent cardiac complications (11% vs 4%; P = .03) compared with patients without AR. After propensity matching, baseline patient characteristics were similar between groups. For perioperative outcomes, the groups did not differ in surgical time, blood loss, length of stay, or complications including anastomotic leaks, bleeding, cardiac, infectious complications, or liver infarct or failure (all; P = not significant). Patency was 97% at a mean follow-up of 510 +/- 184 days with 1 hepatic artery AR thrombosis. Long-term outcomes were significantly different: patients with AR had a lower rate of local tumor recurrence (20% vs 47%; P = .007) but also lower 1-year (50% vs 87%; P = .002) and median survival (22 +/- 18 vs 49 +/- 7 months; P = .002). Conclusions: AR during pancreatectomy is safe and not associated with increased complications. Although it significantly reduces the risk of local tumor recurrence, AR is associated with worse survival compared with patients who do not undergo AR.
引用
收藏
页码:722 / 730
页数:9
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