ASO Author Reflections: Should We Resect the “Unresectable”? Since Alexis Carrel and Joseph G. Fortner, Almost 120 Years of (Pancreatic) Vascular Surgery in New York

Excerpt

Pancreatic cancer presents a twofold challenge. First, it is a systemic disease, and until the introduction of FOLFIRINOX in 2010, systemic treatments were largely ineffective. Second, its anatomic location at the crossroad of vital vascular structures complicates complete local excision. This is one of the few cancers for which resection is performed without removal of the involved vessels (here in the mesenteric root). Can the performance of a similar procedure be envisioned today, for instance in rectal cancer, without the excision of the mesorectum? As early as 1954, Evans¹ stated that “only by extending the scope of the operative attack upon carcinoma of the head of the pancreas can any real hope for cure be entertained.” Pioneers such as Siegel,² who in 1965 replaced the venous axis with a 10-cm autologous graft, and Fortner³ in 1977, who demonstrated the feasibility of arterial resections, were instrumental in developing pancreatic vascular surgery. Despite high postoperative mortality and poor oncologic outcomes at the time, their work laid the groundwork for progress in this field, although it would take more than four decades for these techniques to gain wider acceptance. …