Vascular Resection for Pancreatic Cancer: Annals of Surgery | June 2026

Introduction:

As surgical techniques and perioperative therapies have advanced, vascular resection during pancreatic cancer surgery has become increasingly common in selected patients with locally advanced disease. This study evaluated the long-term outcomes of venous and arterial resections in patients undergoing curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC).

Why was this study needed?

The oncologic benefit of vascular resection, particularly arterial resection, remains controversial because of concerns regarding increased operative risk and uncertain survival benefit.

What did the study show?

• The study analyzed 715 patients undergoing curative-intent surgery over 10 years at a high-volume pancreatic center.
• Venous resection was performed in 30% of patients, while arterial resection was required in 12%.
• Patients undergoing venous resection had shorter recurrence-free and overall survival than those without vascular resection.
• After adjustment for other prognostic factors, vascular resection itself was not an independent predictor of overall survival.
• Arterial resection achieved oncologic outcomes comparable to standard resection but was associated with significantly higher 90-day postoperative mortality.
• Perioperative chemotherapy and chemoradiotherapy significantly improved recurrence-free and overall survival.
• Node-negative disease and absence of perineural invasion were strong predictors of favorable long-term outcomes.

Clinical Impact:

Vascular resection should not be considered a contraindication to curative surgery in carefully selected patients with PDAC. Successful outcomes depend on multidisciplinary management, effective perioperative therapy, and performance in experienced high-volume centers.

Take-Home Message:

Vascular resection can safely expand surgical options for selected patients with pancreatic cancer. While arterial resection carries higher perioperative risk, careful patient selection and modern multimodality therapy can achieve oncologic outcomes comparable to standard pancreatic resection.