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Novel implications of combined arterial resection for locally advanced pancreatic cancer in the era of newer chemo-regimens
Institution:1. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan;13. Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia / Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Spain;14. Epidemiologia Clínica y Cribado de Cáncer, Corporacio Sanitaria Parc Taul?, Sabadell / Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Spain;15. Servicio de Laboratorio, Hospital Costa del Sol, REDISSEC, Málaga, Spain;p. Unidad de Epidemiologia, Distrito Sevilla, Servicio Andaluz de Salud, Spain;q. Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, REDISSEC, Madrid, Spain;r. Unidad de Investigación, Hospital Universitario Donostia /Instituto de Investigación Sanitaria Biodonostia, REDISSEC, Donostia, Spain;s. Unidad de Investigación, Hospital Universitario Basurto, REDISSEC, Bilbao, Spain;t. Servicio de Epidemiologia, Hospital Costa del Sol, REDISSEC, Málaga, Spain;u. Department of Preventive Medicine and Public Health, Univesity of Valencia / CIBER de Epidemiologia y Salud Pública (CIBERESP), CSISP-FISABIO, Valencia, Spain;v. Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid, Spain;w. Unidad Apoyo a Docencia-Investigación, Dirección Técnica Docencia e Investigación, Gerencia Adjunta Planificación, Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid, Spain;x. Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPVREDISSEC, Spain;y. Epidemiologia Clínica y Cribado de Cáncer, Corporació Sanitaria Parc Taul?´, REDISSEC, Sabadell, Spain;z. Servicio de Oncología, Hospital Universitario Basurto, Bilbao, Spain;11. Servicio de Cirugía General, Hospital Universitario Basurto, Bilbao, Spain;12. Servicio de Anatomía Patológica, Hospital Galdakao-Usansolo, Galdakao, Spain;13. Servicio de Cirugía General, Hospital Universitario Araba, Vitoria-Gasteiz, Spain;14. Servicio de Gastroenterología, Hospital Universitario de Canarias, La Laguna, Spain;15. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Spain;16. IMAS-Hospital del Mar, Barcelona, Spain;17. Servicio de Cirugía General y Digestiva, Hospital Universitario, Donostia, Spain;18. Instituto de Investigación Sanitaria Biodonostia, Donostia, Spain;19. Servicio de Cirugía General y Digestiva, Hospital de Mendaro, Spain;110. Servicio de Cirugía General y Digestiva, Hospital de Zumárraga, Spain;111. Servicio de Cirugía General y Digestiva, Hospital del Bidasoa, Spain;112. Servicio de Oncología Médica, Hospital Universitario Donostia, Spain;113. Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain;114. Servicio de Cirugía, Hospital Universitario Virgen de Valme, Sevilla, Spain;115. Servicio de Cirugía General y Aparato Digestivo, Hospital Dr. Pesset, Valencia, Spain;1p. Servicio de Cirugía General y Aparato Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Spain;1q. Servicio de Oncología Médica, Agencia Sanitaria Costa del Sol, Marbella, Spain;1r. Servicio de Cirugía, Hospital de Antequera, Spain;1s. Coloproctology Unit, General and Digestive Surgery Service, Corporacio´ Sanitaria Parc Taul?´, Sabadel, Spain;1t. Digestive Diseases Department, Corporacio´ Sanitaria Parc Taul?´, Sabadell, Spain;1u. Pathology Service, Corporacio´ Sanitaria Parc Taul?´, Sabadell, Spain;1v. Medical Oncology Department, Corporacio´ Sanitaria Parc Taul?´, REDISSEC, Sabadell, Spain;1w. General and Digestive Surgery Service, Parc de Salut Mar, Barcelona, Spain;1x. General and Digestive Surgery Service, Althaia- Xarxa Assistencial Universitaria, Manresa, Spain;1y. Catalonian Cancer Strategy Unit, Department of Health, Institut Català d’Oncología, Spain;1z. Medical Oncology Department, Institut Català d’Oncología, Spain;21. Agency for Health Quality and Assessment of Catalonia–AquAS- and REDISSEC, Spain;22. Agency for Health Quality and Assessment of Catalonia–AQuAS, CIBER de Epidemiologia y Salud Publica, CIBERESP, Spain;23. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, Spain;24. Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid, Spain;25. Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain;26. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain;27. REDISSEC, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Madrid, Spain;28. REDISSEC, Unidad de Gestión Sanitaria, Hospital del Alto Deba, Mondragon-Arrasate, Spain;1. Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain;2. Instituto de Investigación Biomedica de Málaga (IBIMA), Spain;3. Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Spain;4. Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Department of Oncohaematology, Costa del Sol Hospital, Marbella, Spain;5. Clinical Epidemiology and Cancer Screening, Corporació Sanitaria ParcTaulí, REDISSEC, Sabadell, Spain;6. Department of Preventive Medicine and Public Health, University of Valencia, Spain, CIBERESP, Valencia, Spain;7. Servicio de Anatomía Patológica, Hospital de Galdakao, Galdakao, Vizcaya, Spain;8. Servicio de Anatomía Patológica, Hospital de Antequera, Málaga, Spain;9. Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain;10. Departamento de Patología, Complejo Hospitalario de Granada, Instituto de Investigación Biosanitaria y Universidad de Granada, Granada, Spain;11. Research Unit, Basurto University Hospital, REDISSEC, Bilbao, Spain;12. Research Unit, Galdakao-Usansolo Hospital, Galdakao-Usansolo Hospital, REDISSEC, Spain;1. Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625, AD, Delft, the Netherlands;2. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands;3. Department of Geriatric Medicine, Elisabeth – TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022, GC, Tilburg, the Netherlands;4. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands;5. Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands;6. Department of Public Health, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands;1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China;2. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA;1. ESSO Clinical Research Committee, Brussels, Belgium;2. Charité Comprehensive Cancer Center, Berlin, Germany;3. Hospital Universitario de Fuenlabrada, Madrid, Spain;4. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden;5. Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands;6. Centre Léon Bérard, Lyon, France;7. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;8. Dept. of General HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium;9. Social Medical Center South, HPB Center Vienna Clincs, Vienna, Austria;10. Frankfurt University Hospital, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Frankfurt/Main, Germany;11. Universitätsmedizin Mannheim, Mannheim, Germany;12. Leiden University Medical Center, Leiden, Netherlands;13. Aintree University Hospital NHS Trust, Liverpool, United Kingdom;14. Oncology Institute of Vojvodina, Sremska Kamenica, Universty of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;15. Hyogo College of Medicine, Hyogo, Japan;p. EORTC, Brussels, Belgium;q. Gustave Roussy, Université Paris Saclay, Villejuif, France;r. Institut Bergonié, Université de Bordeaux, Bordeaux, France;1. Department of Urologic Surgery, Tianjin Medical University Second Hospital, Tianjin, China;2. Department of Urologic Pathology, Tianjin Urologic Institute, Tianjin, China;3. Department of Radiology, Tianjin Medical University Second Hospital, Tianjin, China;1. Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan;2. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium;3. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan;4. Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Belgium
Abstract:IntroductionIn this study, we assessed the prognostic efficacy and feasibility of combined arterial resection (AR) for locally advanced pancreatic cancer (LAPC), and aimed to identify significant prognostic factors for patients who underwent combined AR.MethodsBetween 1981 and 2018, 733 consecutive patients who underwent pancreatic surgery for PC were identified. The 730 cases with detailed information were enrolled in the analysis.ResultsAmong 730 resected PC patients, 44 (6%) underwent AR including 21 hepatic (48%), 12 celiac (27%), five splenic (12%), four superior mesenteric (9%), and two other arteries (4%). The combined AR surgery showed significantly longer operative time (median, 608 vs 451 min, P < 0.0001), and the incidence of intraoperative blood transfusion was significantly higher in AR than surgery without AR (P = 0.0002), whereas there was no significant difference in the intraoperative blood loss (970 vs 1200 mL, P = 0.2) and occurrence of major complications (P = 0.5). In prognostic analysis of AR cases, multivariate Cox proportional hazard models revealed preoperative and postoperative therapy were the independent factors for both recurrence-free survival (RFS) and overall survival (OS) (preoperative therapy: RFS, HR = 0.21, P = 0.007; OS, HR = 0.18, P = 0.01; postoperative therapy: RFS, HR = 0.31, P = 0.003; OS, HR = 0.19, P = 0.002).ConclusionThis study showed the feasibility of combined AR for LAPC and robust association of pre- and postoperative therapy and survival after AR surgery. Preoperative therapy following combined AR surgery is potentially powerful strategy for LAPC.
Keywords:Pancreatic cancer  Artery resection  Preoperative therapy  Prognosis  PC"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"pancreatic cancer  LAPC"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"locally advanced pancreatic cancer  PV"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"portal vein  SMV"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"superior mesenteric vein  HA"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"hepatic artery  CA"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"celiac artery  SMA"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"superior mesenteric artery  AR"}  {"#name":"keyword"  "$":{"id":"kwrd0105"}  "$$":[{"#name":"text"  "_":"arterial resection  UICC"}  {"#name":"keyword"  "$":{"id":"kwrd0115"}  "$$":[{"#name":"text"  "_":"Union for International Cancer Control  CDC"}  {"#name":"keyword"  "$":{"id":"kwrd0125"}  "$$":[{"#name":"text"  "_":"Clavien-Dindo Classification  RFS"}  {"#name":"keyword"  "$":{"id":"kwrd0135"}  "$$":[{"#name":"text"  "_":"recurrence-free survival  OS"}  {"#name":"keyword"  "$":{"id":"kwrd0145"}  "$$":[{"#name":"text"  "_":"overall survival  POPF"}  {"#name":"keyword"  "$":{"id":"kwrd0155"}  "$$":[{"#name":"text"  "_":"postoperative pancreatic fistula  MST"}  {"#name":"keyword"  "$":{"id":"kwrd0165"}  "$$":[{"#name":"text"  "_":"median survival time
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