Arterial Reconstruction Due to Intraoperative Arterial Injury or Arterial Tumor Involvement During Pancreatectomy-Single Centre Experience in 35 Cases

Background: The incidence of iatrogenic intraoperative arterial injury (AI) during pancreatectomy is not well described. Arterial resection and reconstruction (AR) due to arterial tumor involvement (ATI) is controversial. This study aims to evaluate the incidence of AI during pancreatectomy and the outcome of pancreatectomy with AR due to ATI or AI. Methods: All consecutive patients undergoing pancreatectomy between 2006 and 2016 were included. Results: Of a total of 1526 patients, AI was diagnosed in 13 patients (0.85 %). AI occurred in 10 of 922 pancreatoduodenectomies, 2 of 509 distal pancreatectomies (1 of 22 open, 1 of 488 laparoscopic), 1 of 43 total pancreatectomies, and 0 of 51 enucleations (1 open, 50 laparoscopic). AR was performed due to ATI in 22 patients and AI in 12 patients. AI was associated with aberrant arterial anatomy, peripancreatic inflammation or a combination of the two in all cases. Estimated blood loss for AR-ATI and AR-AI was median 900 ml and 1100 ml. Rate of severe complications (≥ Clavien grade 3) was 11/22 (50 %) and 6/13 (46 %). Ninety-day mortality was 4.5 % (1/22) in AR-ATI and 7.7 % (1/13) in AR-AI. Estimated median overall survival in patients with pancreatic and periampullary adenocarcinoma (n=15) undergoing AR due to ATI was 21 months. Conclusion: The incidence of AI during pancreatectomy was 0.85 %. AR due to ATI or AI is associated with a high rate of severe complications, but an acceptable mortality rate.