Indications and Perioperative Outcomes for Pancreatectomy with Arterial Resection

Abstract Background Pancreatectomy with AR is infrequently performed. As indications evolve, we evaluated indications, outcomes and predictors of mortality, morbidity, and survival after AR. Study Design Single-institution review of elective pancreatectomies with AR (7/1990-7/2017). Univariate/multivariate analyses performed for predictors of outcomes and survival. Results Total of 111 patients underwent pancreatectomy with AR including any hepatic (54%), any celiac (44%), any superior mesenteric (14%), or multiple ARs (14%) with revascularization in 55%. Majority of cases planned (77%) and performed post-2010 (78%). Overall 90-day major morbidity (≥ grade III) and mortality was 54% and 13% due to PPH, POPF, or ischemia in majority of cases. There was a significant decrease in mortality post-2010 (9% vs. 29%, P=0.02), and this was protective on multivariate analysis (OR = 0.1, P = 0.004) whereas PPH increased mortality (OR = 6.1, P Conclusions Regardless of indication or type, pancreatectomy with AR is associated with risks greater than standard resections. Mortality has decreased in modern era; however, morbidity remains high from hemorrhagic, fistula, or ischemia-related complications. Mitigation measures are needed if advanced resections are considered with increasing frequency given the potential oncologic benefit of AR in selected cases after modern chemotherapy.