• borderline resectable
• LAPC
• pancreas
• PDAC

Introduction: Pancreatectomy with en-bloc vein resection (P-VR) is a challenging procedure, although is becoming the standard of care for borderline resectable pancreatic cancer. Pancreatectomy with resection and reconstruction of peri-pancreatic arteries (P-AR) instead is rarely performed.
Methods: A retrospective database prospectively kept was used to define safety, 90-day post-operative and oncological outcomes of the study population, specifically all the P-VR and P-AR performed by a single high-volume center.
Results: Seven-hundred and forty-three patients were operated. During the surgical intervention was performed at least a vascular resection. Five-hundred and ten (68,64%) were vein resection only, forty-five (6,05%) were arterial resection only, which in only 1 (2,22%) patient was a superior mesenteric artery resection. In 202 (27,18%) patients more than one vascular resection was necessary. Concurrent arterio-venous resection was necessary in 188 (25,30%) patients. Two-hundred and eighty-five patients (38,35%) had a totally pancreatectomy. Total gastrectomy was needed in 54 (6,86%) patients, and most of them were performed before 2014. Starting from 1998, 182 (24,49%) patients had received either primary chemotherapy or chemoradiotherapy. Severe post-operative complications were registered in 171 (23,36%) patients. Post-operative mortality at 90-day after surgery was 10,92%. Pancreatic ductal adenocarcinoma (PDAC) was diagnosed, at pathological specimen analysis, in 607 (81,69%) patients. There was no R2 resection. In PDAC the R1 rate was 58,97%. Mean lymph nodes retrieval was 52±27.
Discussion: Pancreatic vascular resection, in prepared and selected patients, is feasible with a high chance of R1-R0 resection and is associated with acceptable post-operative risk. Median overall survival (OS) in PDAC patients was 16,77 months (IQR:8,05-34,23).