Annals of Surgical Oncology Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
10.1245/s10434-008-9844-y
Annals of Surgical Oncology 15:1399-1406 (2008)
© 2008 Society of Surgical Oncology
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Stitzenberg, K. B.
Right arrow Articles by Hoffman, J. P.
PubMed
Right arrow Articles by Stitzenberg, K. B.
Right arrow Articles by Hoffman, J. P.

Original Article

Survival After Pancreatectomy With Major Arterial Resection and Reconstruction

Karyn B. Stitzenberg, MD, MPH1, James Christopher Watson, MD1, Andrew Roberts, MD2, Steven A. Kagan, MD3, Steven J. Cohen, MD4, Andre A. Konski, MD, MBA5 and John P. Hoffman, MD1

1 Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
2 Vascular Surgery, Temple University, 3401N. Broad Street, Parkinson Pavillion, Suite 400, Philadelphia, PA 19140, USA
3 Carolina Vascular Surgery, 2800 Blue Ridge Road, suite 500, Raleigh, NC 27607, USA
4 Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
5 Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania

Correspondence: Address correspondence and reprint requests to: Karyn B. Stitzenberg, MD, MPH; E-mail: karyn.stitzenberg{at}fccc.edu

Background: Absence of major arterial tumor involvement has generally been regarded as a major criterion for resectability of pancreatic tumors. We hypothesize that resection of a tumor-involved hepatic artery (HA) or celiac artery (CA) with reconstruction may offer a survival benefit to patients whose tumors were traditionally regarded as unresectable.

Methods: All patients with pancreatic adenocarcinoma treated between 1996 and 2007 were reviewed. Patients were included if they underwent resection of the HA or CA during pancreatectomy. Survival was analyzed by Kaplan-Meier survivor functions, Cox proportional hazard models, and the log rank test.

Results: Twelve patients (six men and six women) with adenocarcinoma underwent pancreatectomy with resection of a tumor-involved HA (n = 2) and/or CA (n = 10). Median age at diagnosis was 62 years (range, 53–73 years). All patients completed neoadjuvant chemoradiotherapy with or without full dose chemotherapy before resection. Procedures performed were six extended pancreaticoduodenectomies, two proximal subtotal pancreatectomies, two distal pancreatectomies, and two total pancreatectomies. Ten cases involved celiac resections, and two had isolated HA resections. The 60-day mortality was 17% (2 of 12). Median survival after diagnosis was 20 months (range, 6–41 months). Median survival after resection was 17 months (range, 1–36 months). Survival was not statistically significantly related to age, sex, margin status, or preoperative CA19-9 level. The 3-year survival was 17%. There were no 5-year survivors.

Conclusions: Resection of the HA or CA with reconstruction may prolong survival for selected patients who undergo pancreatic resection after neoadjuvant therapy. However, this aggressive approach did not result in any long-term survivors in our series.

Key Words: Extended pancreatectomy • Locally advanced pancreatic cancer • Survival






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the Society of Surgical Oncology.