A histopathological study of artery wall involvement in pancreatic cancer surgery

• Published in: Langenbeck's archives of surgery Vol. 407; no. 8; pp. 3501 - 3511
• Main Authors: Cai, Baobao, Bergmann, Frank, Lu, Zipeng, Neoptolemos, John P., Li, Mingna, Yin, Lingdi, Gao, Yong, Xu, Cheng, Jiang, Kuirong, Büchler, Markus W., Miao, Yi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2022
• Subjects: Abdominal Surgery; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Cardiac Surgery; Celiac Artery - surgery; General Surgery; Humans; Medicine; Medicine & Public Health; Pancreatectomy - methods; Pancreatic Neoplasms; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Artery wall tumour invasion; External elastic lamina; Pancreatic ductal adenocarcinoma; Stage T4; Pancreatectomy; Artery-sparing; Sub-adventitial dissection
• ISSN: 1435-2451; 1435-2451
• DOI: 10.1007/s00423-022-02689-0

Purpose This study aims to study the depth of artery wall tumour invasion in patients undergoing surgery for pancreatic ductal adenocarcinoma. Methods Specimens from 47 pancreatic cancer patients with major arterial (splenic, SA; celiac, CA; common hepatic, CHA) invasion were examined: 45 left (distal) pancreatectomies, including 11 celiac artery resections, and two total pancreatectomies. Dissection of tumour-invaded arteries in 25 fresh specimens was attempted ex vivo using the sub-adventitial dissection technique (SDT). Tumour invasion of 66 arteries was graded using the tumour-free distance (TFD) from the external elastic lamina (EEL): 0 = no arterial invasion; I = TFD ≥ 1 mm; II = TFD < 1 mm; and grade III = EEL invasion. Results AJCC TNM staging was IA = 1 (2%), IB = 4 (9%), IIA = 5 (11%), IIB = 17(36%) and III = 20 (43%). Grade III tumour invasion was found in 17/47(36%) SAs, in 5/11 (45%) CAs and in 1/8 (13%) CHAs ( p  = 0.318). Attempted ex vivo SDT undertaken in 33 arteries from 25 specimens was complete in 16 and incomplete in 17 arteries. The median (IQR) TFD was 0.97 (0.11–2.54) mm in dissected and 0.14 (0.10, 0.14) mm in non-dissected SAs ( p  = 0.034). EEL tumour invasion occurred in 0/12 (0%) dissected compared to 7/13 (54%) non-dissected SAs ( p  = 0.005). Grades 0, I, II and III invasion were found in four (33%), two (17%) and six (50%), respectively, of 12 dissected SAs and grades II and III in six 6 (46%) and seven (54%), respectively, of 13 non-dissected SAs ( p  = 0.002). Conclusions The grading system described may form the basis for classification to further develop arterial dissection techniques for pancreatic cancer.