Role of Vascular Resection in the Surgical Treatment of Pancreatic Cancer

Pancreatic cancer is the 4th cancer-related cause of death in Western countries and it is expected to become the 2nd leading cause of death by 2030. Approximately 80% of patients are unresectable at diagnosis including a 41.4% of patients found unresectable at exploratory laparoscopy/tomy. The reasons for such unresectability stand in undiagnosed metastatic burden but most of all in locally advanced disease beyond limits of surgical treatment. Those limits are however related to the surgeon expertise and experience. Venous resection has been demonstrated as safely feasible in order to achieve clear surgical margins but the discussion about arterial resections is still ongoing. Even though it had been banned for its high surgical risks, recent evidences claim it to give a survival advantage in selected patients. The widespread use of neoadjuvant treatments makes preoperative imaging unreliable in predicting residual vascular invasion. The majority of vascular resections are indeed unplanned. Up to 38% of eventually resected patients need a vascular resection in order to achieve a radical pancreatectomy, just over half of which because of a histological invasion. This is a state of the art of the results of vascular resection in the treatment of pancreatic cancer.