Pancreatoduodenectomy with vascular resection in a population-derived cohort: time-trends, effect on short-term composite outcome and relevance for overall survival

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BACKGROUND: Pancreatoduodenectomy with vascular resections increase complexity and potentially also morbidity and mortality. Data outside single-institution cohorts are limited. Thus, we analysed population-derived trends in pancreatoduodenectomy with vascular resection. METHODS: A registry-based, population-derived cohort (years 2018-2023) of pancreatoduodenectomy ± vascular resection in a universal health care system analysed for effect on short-term composite textbook outcome and overall survival. RESULTS: Of 860 pancreatoduodenectomies, 138 (16%) had concomitant vascular resection (vein resections, n = 120; 87%); n = 14 (10%) artery; n = 4 (3%) combined artery + vein). Vascular resection-rate increased (13.8%-18.3%) over time and most were done for malignancy (n = 113, 82%). Inhospital mortality (2.2% vs. 1.9%) did not differ when adding vascular resection. Composite textbook rates were comparable for pancreatoduodenectomy ± vascular resection (n = 75, 54.3% and n = 430, 59.6%, P = 0.255). Pancreatoduodenectomy with vascular resection had a higher rate of reoperation (16.7% compared to 10.0%; OR 1.81, 95% c.i. 1.09-3.01; P = 0.022), which also differed between regions. Overall long-term survival was significantly shorter if vascular resection was performed without neoadjuvant treatment; no difference was observed after neoadjuvant treatment for pancreatoduodenectomy ± vascular resection. CONCLUSION: The population-derived vascular resection rates increased over time with no noted negative effects on overall complication rate nor for achieved textbook outcome, but a significantly higher risk for reoperations.

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