Patency and Survival Outcomes in a 10-year Experience of Cephalic Pancreatectomy Requiring Vascular Reconstruction

The aim of this study was to evaluate patients submitted to pancreatectomy with vascular invasion requiring revascularization over a period of 10 years (2008-2018), in a single cancer center in Brazil. Outcomes regarding surgical technique, patency rates, use of anticoagulants, and disease-associated mortality were analyzed. We performed a retrospective cohort with 67 patients. Information was collected from computerized medical records. Statistical analyzes were performed using the IBM SPSS software version 25. We identified a higher incidence of the disease in females, 37 patients (55.2%). The mean age was 60.7 years (SD, 10.5 years), and the most frequent comorbidity was diabetes mellitus, observed in 26 patients (38.8%). Adenocarcinoma was the most prevalent histological type, present in 54 patients (81.8%). The most repaired blood vessel was the portal vein in 25 patients (37.3%), and revascularization with primary repair was the most prevalent surgical technique, performed in 46 cases (68.7%). Neoadjuvant treatment with chemotherapy and radiotherapy was performed in 37 (55%) and 23 patients (34.3%), respectively. The disease-free tumor margin was 71.2% (47 patients). The patency rate among the 42 patients who underwent imaging examination was 88.4% in patients with adenocarcinoma submitted to primary repair vs 54% in patients with prosthesis grafts (P = .04). Overall 5-year survival is 34.8%, 31.8% when evaluating only patients with malignant neoplasia, and 23.5% in patients with adenocarcinoma. Pancreatectomy associated with vascular resection and reconstruction appears to increase the survival of patients with pancreatic cancer. Early patency was similar in the different reconstruction modalities, but late patency (>30 days after surgery) was superior in patients who underwent primary repair. The 5-year survival in patients with adenocarcinoma was 23.5% and 31.8% in patients with other malignant tumors.