Pancreaticoduodenectomy with Complex Vascular Reconstruction Is Safe and Oncologically Justified

Introduction: The aim of this study was to analyze the experience in two transplant centers of patients undergoing pancreaticoduodenectomy (PD) with or without vascular reconstruction. Method: We retrospectively reviewed prospectively collected data of all consecutive patients undergoing pancreaticoduodenectomy (PD) for cancer, between 1/1/2013 and 1/31/2018. The overall cohort (n=197) was divided into those with vascular reconstruction (Group1, n=38) and without vascular reconstruction (Group2, n=159). Results: The two groups were similar in terms of age, sex distribution, and pre-operative ASA score. One post-operative portal vein thrombosis was seen in each group (NS). Peri-operative mortality occurred in one patient in Group 2 due to post-op bleeding. Hospital length of stay (8d vs 7d, p=0.14), ICU length of stay (2d vs 1d, p=0.47), and blood loss (350cc vs 300cc) were similar in both groups. The length of surgery was longer in Group 1 (438 minutes vs 341, p<0.0001). Both groups had similar rates of Clavien grade 3 or higher morbidity (15.8% in Group1 and 15.7% in Group2, p=0.83). R0 resection rate was lower in Group 1 (73.7% vs 92.5%, p=0.001). However, the local recurrence rates did not differ between the two groups - 17 (44.7%) in Group 1 and 71 in Group 2 (44.7%, p=0.992). Kaplan-Meier analysis showed no difference in overall and disease-free survival, and also when limiting the pathology to only pancreatic ductal adenocarcinoma. Conclusions: Our experience shows that complex vascular reconstruction in PD can be achieved safely when done by experienced teams, and with comparable cancer outcomes in selected patients.