The distance to arteries predicts the oncological outcome in pancreatic cancer surgery - results from a 3D reconstruction model.

Abstract

Background: Many patients will experience recurrence after oncological pancreatic resection. The success of complete curative resection largely depends on the tumor's proximity to surrounding arteries, such as the celiac axis (CA) and the superior mesenteric artery (SMA). Predicting oncological outcomes before surgery remains a major challenge.

Methods: This retrospective study included patients with histologically proven pancreatic ductal adenocarcinoma (PDAC) who underwent pancreatic resection. Preoperative contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) was used to determine the shortest distance between the tumor and the corresponding artery. The cohort was subdivided into three groups: direct contact (representing borderline resectability), close proximity (>0 to ≤5 mm), and greater distance (>5 mm) between the tumor and the closest artery. An analysis of the oncological outcomes for each group was performed.

Results: Among the 180 included patients, the direct contact group was associated with an increased rate of local recurrence (46.9 %) compared to the close proximity and greater distance groups (41.0 % and 38.6 %, respectively). The R1 resection rates were also significantly higher in the direct contact group (38.6 % vs. 23.0 % and 20.0 %, respectively; p < 0.05). In the survival analysis, patients with a greater distance had a significantly longer time to recurrence (15.4 vs. 10.8 vs 6.5 months) and median overall survival (33.7 vs. 20.8 vs. 14.0 months) than patients with close proximity or contact to the nearest artery.

Conclusion: Measurement of the distance to the closest artery in preoperative imaging has strong prognostic value for recurrence and overall survival in patients with resectable PDAC.