Outcomes following pancreatoduodenectomy with arterial, venous, or no vascular resection: NSQIP database analysis

Evaluation of arterial resection (AR) during pancreatoduodenectomy (PD) is limited. Analysis of the U.S. National Surgical Quality Improvement Program (NSQIP) database compared PD with AR to PD with venous resection (VR) and no vascular resection (NVR) over 5 years (2017-2021). Propensity score matched (PSM) analysis was used. Among 28,083 patients, 4.1% had AR and 10.9% had VR. After demographic adjustment, both AR (OR 1.40; p<0.001) and VR (1.32; p<0.001) were independently associated with 30-day serious complications and mortality. PSM supported increased serious complications (+ 4.9% VR, p<0.001; + 5.40% AR, p=0.008) but not mortality (+0.4% VR, p=0.323; +1.4% AR; p=0.067) compared to NVR. AR did not increase risk of complications or mortality compared to VR following PSM. Evaluating AR/VR from 2017 to 2021 shows consistent demographics but increasing neoadjuvant treatment (from 40.2% to 48,9%; p<0.001). Length of stay has decreased (from 12.3 days to 9.6 days; p<0.001), while serious complications (19.7% to 22.1%) and mortality (1.7% to 3.1%) remained similar. The authors conclude that AR and VR during PD are independently associated with 30-day serious complications compared to NVR. However, absolute morbidity rates during vascular resection may be acceptable in selected patients and appear to be similar with AR and VR (graphical abstract).