Synchronous arterial resections in pancreatic cancer – still a matter of debate? |
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| Institution: | 1. Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia;2. College of Medicine and Public Health, Flinders University, South Australia, Australia;3. Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany;1. Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland;2. UCD Centre for Precision Surgery, Section of Surgery and Surgical Specialties, School of Medicine, University College Dublin, Dublin, Ireland;1. Academic Unit of Colorectal Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 10 – 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK;2. Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK;3. Undergraduate School of Medicine, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ, Scotland, UK;4. Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, G31 2ER, Scotland, UK;1. Department for Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany;2. Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany;3. Department of Dermatology, University Hospital Essen, Essen, Germany;4. Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany;5. SRH Wald-Klinikum Gera, Gera, Germany;6. Department of Dermatology and Allergy, University Hospital, LMU München, Munich, Germany;7. Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven Reinkenheide GGmbH, Bremerhaven, Germany;8. Department of Dermatology, University Hospital of Regensburg, Regensburg, Germany;9. Department of Dermatology, University Hospital Augsburg, Augsburg, Germany;10. Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany;1. Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia;2. Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia;3. Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany;4. Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Germany;5. American Cancer Society, Surveillance & Health Services Research, Atlanta, GA;6. City of Hope National Medical Center, Division of Breast Surgery, Department of Surgery, Duarte, Los Angeles County, CA;1. Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097, Halle (Saale), Germany;2. Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, D-45122, Essen, Germany;1. Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, University Medical Center Halle, Halle, Germany;2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany;3. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland;4. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;5. Institute for Pathology, Industriestr. 11c, 67063, Ludwigshafen, Germany |
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| Abstract: | Surgery remains the cornerstone of a multimodality approach aimed at cure in pancreatic cancer (PC). To improve outcomes in PC and widen the indications for surgical resection, surgeons have targeted borderline-resectable (BR) and locally advanced (LA) tumours having demonstrated the feasibility of synchronous arterial (SAR) and venous resections (SVR). However, the true benefit of SARs in PC in terms of improving overall survival has not been fully realised. One of the reasons for this lies in the fact that once the tumour involves the artery, it has already spread along the perineural autonomic plexus that surround it, resulting in early extended local and distant cancer dissemination. Thus, before advocating for the performance of routine SARs in PC, it is important to critically analyse the evidence and develop a structured framework to test if these operations truly hold a beacon of hope for patients with LAPC. |
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| Keywords: | Statistics Survival Morbidity Mortality |
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