Vascular resection for pancreas cancer: Ten-year real-world experience from a single high-volume center.

Authors

null

David Henault

University Health Network, Toronto, ON, Canada

David Henault , Holden Kunde , Cody Zatzman , Daniela Bevacqua , Danielle Arshinoff , Sean P. Cleary , Laura A. Dawson , Elena Elimova , Robert C Grant , Ali Hosni , Raymond Woo-Jun Jang , Jennifer J. Knox , Ian M. McGilvray , Aruz Mesci , Malcolm J. Moore , Carol-Anne Moulton , Trevor Reichman , Chaya Shwaartz , Erica S Tsang , Steven Gallinger

Organizations

University Health Network, Toronto, ON, Canada, University of Toronto, Toronto, ON, Canada, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Princess Margaret Cancer Centre, Toronto, ON, Canada, Department of Radiation Oncology - Princess Margaret - University Health Network, Toronto, ON, Canada, Toronto General Hospital, Toronto, ON, Canada, Hepatobiliary/Pancreatic Surgical Oncology Program, University Health Network, Toronto, ON, Canada

Research Funding

No funding sources reported

Background: In pancreatic ductal adenocarcinoma (PDAC), to identify prognostic factors for surgically treated patients, including vascular resections. Methods: Retrospective review (2011 – 2023) of pathologically proven PDAC treated with curative-intent surgery (n = 715) at a high-volume cancer center. We tested associations between clinicopathological and radiological data, perioperative therapy, time to recurrence (TTR) and overall survival (OS). Results: Demographic and clinicopathological variables were comparable to published surgical cohorts. Initial NCCN radiological staging was 533 (74.5%) resectable, 98 (13.7%) borderline, and 84 (11.7%) locally advanced PDAC. There were 467(65.3%) pancreaticoduodenectomies, 104 (14.5%) distal pancreatectomies, 31 (4.3%) total pancreatectomies and 112 (15.7%) aborted procedures, mostly due to metastatic disease (82.1%). Of the 603 resected cases, 351 (58.2%) were non-vascular resections (NVR), 181 (30.0%) venous-only resections (VR), and 70 (11.8%) were arterial ± venous resections (AR). Median length of stay was 8 days, ICU admission rate was 6.1% (n = 37), readmissions occurred in 114 (18.9%) cases and reoperations in 47 (7.8%) cases. The 90-day mortality rate was 3.2% (n = 19) and the 5-year OS was 20.7%. Perioperative chemotherapy was given to 258 (78.4%) NVR, 129 (75.9%) VR and 60 (93.8%) AR. Perioperative chemoradiation was given to 20 (6.8%) NVR, 34 (21.0%) VR and 43 (66.1%) AR. Median TTR and OS did not significantly differ by initial NCCN staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 months) compared to NVR (18.6 and 30.5 months, p<0.001) and AR (20.6 months, p = 0.004 and 30.9 months, p = 0.017). Patients who received chemotherapy or chemoradiation had significantly longer TTR (20.1 vs. 10.2 months, p<0.001 and 25.3 vs. 16.4 months, p<0.001) and OS (31.5 vs. 17.2 months, p<0.001 and 35.5 vs. 27.5 months, p=0.030) compared to patients not receiving any therapy. In multivariate analysis, when controlling for perioperative therapy and usual clinicopathological factors, vascular resection was not associated with TTR and OS. Perioperative chemotherapy, chemoradiation, pathological N0 status, and absence of perineural invasion were significant independent predictors of longer TTR and OS. For VR specifically, patients who received chemotherapy and chemoradiation had significantly longer median TTR and OS (41.9 and 35.3 months) compared to patients receiving chemotherapy alone (14.3 and 24.6 months, p<0.001 and p=0.017) or receiving no perioperative therapy (9.5 and 12.8 months, p <0.001 and p = 0.004). Conclusions: In this cohort of patients with PDAC treated with surgical resection at a high-volume cancer center, vascular resection was not associated with oncological outcomes when controlling for administration of perioperative therapy.

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Abstract Details

Meeting

2024 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Pancreatic Cancer,Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Small Bowel Cancer

Sub Track

Patient-Reported Outcomes and Real-World Evidence

Citation

J Clin Oncol 42, 2024 (suppl 3; abstr 638)

DOI

10.1200/JCO.2024.42.3_suppl.638

Abstract #

638

Poster Bd #

K7

Abstract Disclosures

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