BACKGROUND The outcomes in patients with pancreatic or ampulla tumors remain unsatisfactory, especially with invasion into the hepatic artery (HA) or the superior mesenteric artery (SMA). In this setting, pancreatectomy combined with arterial resection and reconstruction may offer the possibility of an en-block resection with negative margins and acceptable morbidity and mortality. METHODS A six year retrospective review of pancreatectomies performed at our institution, included 21 patients that underwent a pancreatectomy combined with arterial resection and reconstruction. Arterial reconstruction was performed under an operating microscope. The types of arterial reconstruction included direct anastomosis, arterial transposition, and arterial bypass with a vascular graft. RESULTS The surgical procedures consisted of 19 pancreaticoduodenectomies and 2 total pancreatectomies. The tumors were located at the pancreatic head (n = 10), whole pancreas (n = 2), distal common bile duct (n = 5), ampulla (n = 2) and retroperitoneum with pancreatic head involvement (n = 2). All operations achieved R0 resection successfully, with no intraoperative complication. Eighteen patients recovered without complications while three patients died from intra-abdominal hemorrhage due to a pancreatic fistula, though notably the bleeding was not at the arterial anastomosis site. All reconstructed arteries showed adequate patency at follow-up. The median postoperative survival was 11.6 months in all the 11 patients with pancreatic adenocarcinoma. CONCLUSION Pancreatectomy combined with arterial resection and reconstruction is a feasible treatment option. The microsurgical technique is critically important to achieving a successful and patent arterial anastomosis.

中文翻译：

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胰腺切除术中的动脉切除和重建：手术技术和预后。

背景技术患有胰腺或壶腹部肿瘤的患者的结果仍然不能令人满意，尤其是当侵入肝动脉（HA）或肠系膜上动脉（SMA）时。在这种情况下，胰腺切除术与动脉切除和重建相结合可能会提供全切术，切缘阴性，发病率和死亡率均可接受。方法对我们机构进行的胰腺切除术进行了为期六年的回顾性审查，其中包括21例接受了胰腺切除术，动脉切除和重建的患者。在手术显微镜下进行动脉重建。动脉重建的类型包括直接吻合，动脉移位和带血管移植的动脉搭桥术。结果手术方法包括19例胰十二指肠切除术和2例全胰切除术。肿瘤位于胰头（n = 10），整个胰腺（n = 2），远端胆总管（n = 5），壶腹（n = 2）和腹膜后腹并累及胰头（n = 2）。所有手术均成功完成R0切除，无术中并发症。18例患者无并发症地恢复，而3例因胰瘘而因腹腔内出血死亡，尽管值得注意的是出血不在动脉吻合部位。随访时所有重建的动脉均显示足够的通畅性。在所有11例胰腺腺癌患者中，术后中位生存期为11.6个月。结论胰腺切除术结合动脉切除和重建术是一种可行的治疗选择。显微外科技术对成功实现动脉专利吻合至关重要。