Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction

Ryan S. Turley, Kirk Peterson, Andrew S. Barbas, Eugene P. Ceppa, Erik K. Paulson, Dan G. Blazer, Bryan M. Clary, Theodore N. Pappas, Douglas Tyler, Richard L. McCann, Rebekah R. White

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Once thought to have unresectable disease, pancreatic cancer patients with portal venous involvement are now reported to have comparable survival after pancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared with patients without vascular involvement. We hypothesize that a multidisciplinary approach involving a vascular surgeon will minimize morbidity and improve patency of VRs. Methods: We identified 204 patients who underwent PD for pancreatic adenocarcinoma from 1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with those who underwent standard PD (N = 162). VRs were performed by a vascular surgeon and involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9) with femoral or other venous conduit. Results: Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) but did not have different rates of tumor-free margins (73% vs. 72%, P = 0.84) or lymph nodes metastases (50% vs. 38%, P = 0.14). The VR group had higher median blood loss (875 mL vs. 550 mL, P = 0<0.01), but no differences in mortality, complication rates, length of stay, or readmission rates were found in a median follow-up of 29 months. Overall survival rates were similar. Predictors of mortality on multivariate analysis included increasing histological grade (P = 0.01), positive lymph nodes (P = 0.01), and increasing tumor size (P = 0.01), but not VR (P = 0.28). When evaluated by computed tomography scans within 6 months postoperatively, 97% of reconstructions remained patent. Conclusions: The need for VR is not a contraindication to potentially curative resection in patients with pancreatic adenocarcinoma. Assistance of a vascular surgeon during VR may allow moderate-volume centers to achieve outcomes comparable with high-volume centers.

Original languageEnglish (US)
Pages (from-to)685-692
Number of pages8
JournalAnnals of Vascular Surgery
Volume26
Issue number5
DOIs
StatePublished - Jul 2012
Externally publishedYes

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Pancreaticoduodenectomy
Blood Vessels
Adenocarcinoma
Lymph Nodes
Mortality
Thigh
Pancreatic Neoplasms
Veins
Length of Stay
Neoplasms
Multivariate Analysis
Survival Rate
Tomography
Neoplasm Metastasis
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Turley, R. S., Peterson, K., Barbas, A. S., Ceppa, E. P., Paulson, E. K., Blazer, D. G., ... White, R. R. (2012). Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction. Annals of Vascular Surgery, 26(5), 685-692. https://doi.org/10.1016/j.avsg.2011.11.009

Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction. / Turley, Ryan S.; Peterson, Kirk; Barbas, Andrew S.; Ceppa, Eugene P.; Paulson, Erik K.; Blazer, Dan G.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas; McCann, Richard L.; White, Rebekah R.

In: Annals of Vascular Surgery, Vol. 26, No. 5, 07.2012, p. 685-692.

Research output: Contribution to journalArticle

Turley, RS, Peterson, K, Barbas, AS, Ceppa, EP, Paulson, EK, Blazer, DG, Clary, BM, Pappas, TN, Tyler, D, McCann, RL & White, RR 2012, 'Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction', Annals of Vascular Surgery, vol. 26, no. 5, pp. 685-692. https://doi.org/10.1016/j.avsg.2011.11.009
Turley, Ryan S. ; Peterson, Kirk ; Barbas, Andrew S. ; Ceppa, Eugene P. ; Paulson, Erik K. ; Blazer, Dan G. ; Clary, Bryan M. ; Pappas, Theodore N. ; Tyler, Douglas ; McCann, Richard L. ; White, Rebekah R. / Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction. In: Annals of Vascular Surgery. 2012 ; Vol. 26, No. 5. pp. 685-692.
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abstract = "Background: Once thought to have unresectable disease, pancreatic cancer patients with portal venous involvement are now reported to have comparable survival after pancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared with patients without vascular involvement. We hypothesize that a multidisciplinary approach involving a vascular surgeon will minimize morbidity and improve patency of VRs. Methods: We identified 204 patients who underwent PD for pancreatic adenocarcinoma from 1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with those who underwent standard PD (N = 162). VRs were performed by a vascular surgeon and involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9) with femoral or other venous conduit. Results: Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) but did not have different rates of tumor-free margins (73{\%} vs. 72{\%}, P = 0.84) or lymph nodes metastases (50{\%} vs. 38{\%}, P = 0.14). The VR group had higher median blood loss (875 mL vs. 550 mL, P = 0<0.01), but no differences in mortality, complication rates, length of stay, or readmission rates were found in a median follow-up of 29 months. Overall survival rates were similar. Predictors of mortality on multivariate analysis included increasing histological grade (P = 0.01), positive lymph nodes (P = 0.01), and increasing tumor size (P = 0.01), but not VR (P = 0.28). When evaluated by computed tomography scans within 6 months postoperatively, 97{\%} of reconstructions remained patent. Conclusions: The need for VR is not a contraindication to potentially curative resection in patients with pancreatic adenocarcinoma. Assistance of a vascular surgeon during VR may allow moderate-volume centers to achieve outcomes comparable with high-volume centers.",
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AU - Turley, Ryan S.

AU - Peterson, Kirk

AU - Barbas, Andrew S.

AU - Ceppa, Eugene P.

AU - Paulson, Erik K.

AU - Blazer, Dan G.

AU - Clary, Bryan M.

AU - Pappas, Theodore N.

AU - Tyler, Douglas

AU - McCann, Richard L.

AU - White, Rebekah R.

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N2 - Background: Once thought to have unresectable disease, pancreatic cancer patients with portal venous involvement are now reported to have comparable survival after pancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared with patients without vascular involvement. We hypothesize that a multidisciplinary approach involving a vascular surgeon will minimize morbidity and improve patency of VRs. Methods: We identified 204 patients who underwent PD for pancreatic adenocarcinoma from 1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with those who underwent standard PD (N = 162). VRs were performed by a vascular surgeon and involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9) with femoral or other venous conduit. Results: Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) but did not have different rates of tumor-free margins (73% vs. 72%, P = 0.84) or lymph nodes metastases (50% vs. 38%, P = 0.14). The VR group had higher median blood loss (875 mL vs. 550 mL, P = 0<0.01), but no differences in mortality, complication rates, length of stay, or readmission rates were found in a median follow-up of 29 months. Overall survival rates were similar. Predictors of mortality on multivariate analysis included increasing histological grade (P = 0.01), positive lymph nodes (P = 0.01), and increasing tumor size (P = 0.01), but not VR (P = 0.28). When evaluated by computed tomography scans within 6 months postoperatively, 97% of reconstructions remained patent. Conclusions: The need for VR is not a contraindication to potentially curative resection in patients with pancreatic adenocarcinoma. Assistance of a vascular surgeon during VR may allow moderate-volume centers to achieve outcomes comparable with high-volume centers.

AB - Background: Once thought to have unresectable disease, pancreatic cancer patients with portal venous involvement are now reported to have comparable survival after pancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared with patients without vascular involvement. We hypothesize that a multidisciplinary approach involving a vascular surgeon will minimize morbidity and improve patency of VRs. Methods: We identified 204 patients who underwent PD for pancreatic adenocarcinoma from 1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with those who underwent standard PD (N = 162). VRs were performed by a vascular surgeon and involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9) with femoral or other venous conduit. Results: Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) but did not have different rates of tumor-free margins (73% vs. 72%, P = 0.84) or lymph nodes metastases (50% vs. 38%, P = 0.14). The VR group had higher median blood loss (875 mL vs. 550 mL, P = 0<0.01), but no differences in mortality, complication rates, length of stay, or readmission rates were found in a median follow-up of 29 months. Overall survival rates were similar. Predictors of mortality on multivariate analysis included increasing histological grade (P = 0.01), positive lymph nodes (P = 0.01), and increasing tumor size (P = 0.01), but not VR (P = 0.28). When evaluated by computed tomography scans within 6 months postoperatively, 97% of reconstructions remained patent. Conclusions: The need for VR is not a contraindication to potentially curative resection in patients with pancreatic adenocarcinoma. Assistance of a vascular surgeon during VR may allow moderate-volume centers to achieve outcomes comparable with high-volume centers.

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