Arterial resection and divestment in pancreatic cancer surgery in the era of multidisciplinary treatment: decadal comparative study.

Background: The aim of this study was to investigate the feasibility and effectiveness of pancreatectomy with arterial resection/divestment for pancreatic cancer with arterial involvement in the modern era of multidisciplinary treatment.

Methods: Patients who underwent pancreatectomy with arterial resection/pancreatectomy with arterial divestment for pancreatic cancer with arterial involvement from 2010 to 2021 were retrospectively analysed, and outcomes were compared between the former (2010-2015) and latter interval (2016-2021). Survivals were compared by univariable and multivariable analyses.

Results: Among 203 patients included, 76 underwent pancreatectomy with arterial resection and 127 underwent pancreatectomy with arterial divestment. Compared with the former interval, more patients received preoperative chemotherapy (26.6% (n = 21) versus 95% (n = 118), P < 0.001), and underwent pancreatectomy with arterial resection (30.4% (n = 24) versus 41.9% (n = 52), P = 0.287) in the latter interval. The major morbidity rate and pancreatic fistula decreased in the latter interval (major morbidity rate: P = 0.040; pancreatic fistula: P = 0.006), even among patients undergoing pancreatectomy with arterial resection (major morbidity rate: P = 0.013; pancreatic fistula: P < 0.001). Patients in the latter interval had better overall survival (26.0 versus 48.2 months, P = 0.001), even among patients undergoing pancreatectomy with arterial resection (22.0 versus 45.1 months, P = 0.076).

Conclusions: Within the context of modern multidisciplinary treatment, radical resection including arterial resection should be justified for patients with pancreatic cancer with arterial involvement, considering the acceptable perioperative risk and prolonged survival.