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Invited Critique
April 2013

Show Us the Money: Comment on “Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease”

Author Affiliations

Author Affiliation: Ohio State University Wexner Medical Center, Columbus, Ohio.

JAMA Surg. 2013;148(4):339. doi:10.1001/jamasurg.2013.1068

This first population-based study by Worni and colleagues1 allows broad insight into the immediate outcomes of vascular reconstruction (VR) in pancreatic cancer as practiced in the United States. It included 412 patients with VR—far more than in other studies. The key findings are that the frequency of VR increased from less than 1% in 2001 to greater than 6% in 2009; VR was associated with higher risks for intraoperative and postoperative complications and no increase in length of stay or mortality; and the 25% of highest-volume centers had higher rates of postoperative complications and mortality for patients who underwent pancreatic surgery with VR vs without VR.1 The study did not address survival. In my opinion, the conclusions are scientifically sound and valid, and they should give us pause to reconsider the role of VR in pancreatic cancer.