Periarterial divestment for borderline and locally advanced pancreatic cancer: An analysis of 125 cases in a single center

Abstract

Background

Literature on factors influencing prognosis after periarterial divestment for borderline resectable or locally advanced pancreatic ductal adenocarcinoma and preventative measures for postpancreatectomy hemorrhage is scarce. This study aimed to evaluate the efficacy of Neuro-Patch for arterial reinforcement in preventing postpancreatectomy hemorrhage and explore the oncologic outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma following periarterial divestment.

Methods

We conducted a retrospective analysis of 125 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma involving arteries who underwent periarterial divestment between January 2018 and May 2022.

Results

Among the study cohort, 54 patients underwent pancreaticoduodenectomy, 43 had distal pancreatectomy, and 28 received total pancreatectomy, with 74 patients also undergoing combined venous resection. Periarterial divestment was performed on the hepatic artery in 47 patients, the celiac artery in 3, the superior mesenteric artery in 22, and multiple arteries in 53. Neoadjuvant chemotherapy was administered to 24% of patients, with an R0 resection rate of 33.6%. The median postoperative hospital stay was 10 days, with a 90-day mortality rate of 3.2%. Neuro-Patch was used in 51 patients, leading to a significant reduction in postpancreatectomy hemorrhage (odds ratio 0.073, 95% confidence interval 0.007–0.783, P = .031). The median overall survival was 20.6 months, with 1- and 3-year survival rates estimated at 73.2% and 22.9%, respectively. Neoadjuvant chemotherapy (hazard ratio 0.494, 95% confidence interval 0.291–0.839, P = .009) and venous invasion (hazard ratio 2.041, 95% confidence interval 1.308–3.186, P = .002) emerged as independent predictors of overall survival.

Conclusion

Neoadjuvant chemotherapy significantly enhances survival outcomes of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma undergoing periarterial divestment, and it should be regarded as a standard preoperative approach. The Neuro-Patch provides structural reinforcement to the arterial wall, potentially reducing the risk of postpancreatectomy hemorrhage. However, randomized controlled trials are necessary to substantiate its efficacy and safety.