Outcomes Following Total Pancreatectomy With and Without Vascular Resection: A NSQIP Analysis Comparing Trends in Patient Selection and Outcomes Over 5 Years

INTRODUCTION: Advances in neoadjuvant therapy and surgical techniques have led to more total pancreatectomies (TP) with vascular resection for pancreatic cancer. This study assesses contemporary outcomes of TP with venous (VR) and arterial (AR) resections compared to non-vascular resection (NVR). METHODS: A multicenter, retrospective cohort study was performed using ACS NSQIP data from 2017 to 2021. Patients were divided into three cohorts: NVR, VR only, and AR. Demographics, comorbidities, 30-day post-operative morbidity, and year-to-year trends were analyzed. Multivariable models and propensity score matching evaluated the impact of vascular resection on complications. RESULTS: Of 1101 TP patients, 78.0% had NVR, 15.5% VR, and 6.4% AR. VR and AR patients were older. AR had significantly higher major complication rates (40.9%) than VR (25.2%) and NVR (20.6%). Multivariable analysis identified VR (OR 1.75; p = 0.020) and AR as independent predictors of major complications (OR 3.66; p < 0.001). Year-to-year analysis showed increasing rates of AR, more than doubling from 4.0% in 2017 to 9.3% in 2021, while patient demographics and outcomes remained stable. CONCLUSIONS: Rates of vascular resection in TP are increasing, emphasizing the need to reassess patient outcomes following these complex surgeries. Both VR and especially AR are independently associated with major post-operative complications and should remain reserved for optimally fit patients with ideal biologic disease.