title: Is there a role for arterial reconstruction in surgery for pancreatic cancer?
abstract: Surgery remains the only potentially curative treatment for patients with pancreatic cancer. Locally advanced pancreatic cancer with vascular involvement remains a surgical challenge because high perioperative risk and the uncertainty of a survival benefit. Whilst portal vein resection has started to gather momentum because the perioperative morbidity and long term survival is comparable to standard pancreatectomy, there isn't yet a consensus on arterial resections. There have been various reports and case series of arterial resections in pancreatic cancer, with mixed survival results. Mollberg et al have appraised the heterogeneous published literature available on arterial resection in pancreatic cancer in an attempt to compare this to standard pancreatectomy. In this article, we discuss the results of this systematic review and meta-analysis, and the limitations associated with analysing results from heterogenous data. We have outlined the important features in surgery for pancreatic cancer and specifically to arterial resections, and compared arterial resections to the published literature on venous resections.
authors.affiliation: Reena Ravikumar, David Holroyd, Giuseppe Fusai, Department of Hepatopancreato-biliary and Liver Transplant Surgery, Royal Free London Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom.
authors.forename: Reena
authors.initials: R
authors.lastname: Ravikumar
authors.forename: David
authors.initials: D
authors.lastname: Holroyd
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fusai
keywords: Arterial resection; Coeliac axis; Hepatic artery; Pancreatectomy; Pancreatic cancer; Vascular resection
references.citation: Surgery. 2012 Jan;151(1):61-9
references.pmid: 22088810
references.citation: J Surg Oncol. 2011 Jan 1;103(1):75-84
references.pmid: 21105000
references.citation: J Am Coll Surg. 2008 May;206(5):833-46; discussion 846-8
references.pmid: 18471707
references.citation: Surgery. 2009 Nov;146(5):869-81
references.pmid: 19744432
references.citation: Br J Surg. 2006 Oct;93(10):1232-7
references.pmid: 16804874
references.citation: Ann Surg. 2011 Dec;254(6):882-93
references.pmid: 22064622
references.citation: Best Pract Res Clin Gastroenterol. 2006 Apr;20(2):349-64
references.pmid: 16549332
references.citation: J Gastrointest Surg. 2009 Jan;13(1):26-34
references.pmid: 18946644
references.citation: Arch Surg. 2009 Feb;144(2):154-9
references.pmid: 19221327
references.citation: Ann Surg. 2008 Feb;247(2):300-9
references.pmid: 18216537
references.citation: J Gastrointest Surg. 2010 Sep;14(9):1442-52
references.pmid: 20379794
references.citation: Eur J Surg Oncol. 2008 Dec;34(12):1309-15
references.pmid: 18325723
references.citation: Surg Clin North Am. 2010 Apr;90(2):309-22
references.pmid: 20362788
references.citation: J Gastrointest Surg. 2004 Dec;8(8):935-49; discussion 949-50
references.pmid: 15585381
references.citation: Ann Surg Oncol. 2008 May;15(5):1399-406
references.pmid: 18320285
references.citation: Surgery. 1973 Feb;73(2):307-20
references.pmid: 4265314
references.citation: Eur J Surg Oncol. 2012 Jan;38(1):72-9
references.pmid: 22054617
references.citation: J Hepatobiliary Pancreat Surg. 2009;16(6):850-7
references.pmid: 19844653