RS14 - Patency of Major Abdominal Vessel Reconstructions When Assisting in Whipple Procedures

Objectives: Pancreaticoduodenectomy (PD) is the surgical intervention of choice for pancreatic adenocarcinomas. Currently, only 20% of patients are classified as having resectable tumors at time of diagnosis. For this reason, expanding what cancers are deemed resectable could have a large impact on the pancreatic adenocarcinoma patient population’s life-span as well as quality of life. When pancreatic neoplasms involve major abdominal vessels, not only is survival of paramount consideration, but the patency of reconstructions after resection is also of critical importance. This study aims to analyze patency rates after vascular reconstructions performed during PD for pancreatic adenocarcinoma.

Methods: Our retrospective single-institution cohort analysis included all patients from 2015-2024 who underwent PD for pancreatic adenocarcinoma with the intraoperative assistance of vascular surgery. Demographic, oncologic, and procedural data were obtained including stage 1-4 per tumor board, blood vessels involved in the resection, type of repair performed by the vascular surgeon, and the type of conduit implemented. Our primary outcomes were one- and two-year patency. Unadjusted logistic regression was performed to primary outcomes amongst stage and conduit cohorts.

Results: Of the 50 patients who underwent resection, 14 (28%) were classified as Stage-1, 29 (58%) Stage-2, 6 (12%) Stage-3, and 1 (2%) Stage-4. A total of 9 patients were lost to follow-up before 1-year. Amongst survivors, 89% of repairs within the Stage-1 cohort remained patent at 1-year, while 73% remained patent within the Stage-2 cohort (OR=0.333,p=0.35;Figure I). After 2-years, 80% of repairs in the surviving Stage-1 cohort were patent, while 64% were patent in the surviving Stage-2 group (OR=0.450,p=0.0.52). 100% of the surviving Stage-3 cohort remained patent at 1-year and 2-year, though they experienced 66% mortality within 1 year. When stratified by conduit type, primary repair had the best patency with 94% patent in survivors at 1- and 2-years (Table I). Conversely, Internal Jugular Vein conduits had the worst patency with 50% and 33% patent in survivors, at 1- and 2-years respectively. Bovine patch repairs had 100% patency in survivors at 1 year, but no 2-year patency data was available due to loss to follow-up. No patients had an infected conduit at any time point.

Conclusions: Our analysis presents excellent patency results in major abdominal vessel reconstruction in cancer patients, with no difference in patency results between Stage-1 and Stage-2 cohorts. This indicates that more aggressive resection of pancreatic cancers, even when intimately involved with major abdominal vessels, may be a viable strategy when involving a vascular surgeon.