title: Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement.
abstract: Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.
  
  
  METHODS
  All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.
  
  
  RESULTS
  Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.
  
  
  CONCLUSIONS
  Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.
authors.affiliation: Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France.|Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Perinel
authors.affiliation: Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Nappo
authors.affiliation: Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France.|Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: El Bechwaty
authors.affiliation: Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.|Hospices Civils de Lyon, Department of Digestive Oncology, Edouard Herriot Hospital, Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Walter
authors.affiliation: Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.|Hospices Civils de Lyon, Department of Pathology, Edouard Herriot Hospital, Lyon, France.
authors.forename: V
authors.initials: V
authors.lastname: Hervieu
authors.affiliation: Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.|Hospices Civils de Lyon, Department of Digestive Radiology, Edouard Herriot Hospital, Lyon, France.
authors.forename: P J
authors.initials: PJ
authors.lastname: Valette
authors.affiliation: Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France.|Hospices Civils de Lyon, Department of Vascular surgery, Edouard Herriot Hospital, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Feugier
authors.affiliation: Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France. mustapha.adham@chu-lyon.fr.|Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France. mustapha.adham@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Adham
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001158:Arteries / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Arterial resection; Borderline pancreatic cancer; Locally advanced pancreatic cancer; Pancreas cancer; Vascular resection