Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma

Abstract

Hypothesis: The depth of portal vein (PV) wall invasion is a prognostic factor for survival after curative pancreatic resection for pancreatic ductal adenocarcinoma.

Design: Retrospective clinical study.

Setting: Department of digestive surgery and transplantation.

Patients: From January 1, 1990, through December 31, 2002, 121 patients underwent a curative pancreatic resection for ductal adenocarcinoma of the pancreas. Among these, 37 pancreatic resections combined with PV resection were performed.

Main outcome measures: Prognostic factors for survival and predictive factors for the depth of PV wall invasion.

Results: The morbidity and mortality rates did not differ between patients undergoing or not undergoing PV resection (32.4% and 2.7% [1/37], respectively, vs 38.1% and 2.4% [2/84], respectively). The 3-year survival rate after curative pancreatic resection was significantly associated with the depth of PV wall invasion. Indeed, the 3-year overall survival rate was similar for patients with no PV invasion and those with superficial invasion into the tunica adventitia (40.0% vs 32.9%, respectively; P = .85). Deeper PV wall invasion into the tunica media or the tunica intima was associated with a poorer 1-year survival rate similar to that of patients undergoing noncurative resection (21.5% vs 34.4%, respectively; P = .53). Multivariate analysis showed that the depth of PV wall invasion, number of involved lymph nodes, and volume of blood transfusion were independent factors of overall and disease-free survival. Tumor size of 45 mm or more (evaluated by computed tomography) and angiographic type C or D on a portogram were significantly correlated with the depth of PV wall invasion. Patients presenting with both factors simultaneously had poor survival.

Conclusions: The depth of PV wall invasion significantly alters survival after curative pancreatic resection combined with PV resection. However, occasional long-term survival could be observed after curative resection in patients with deep PV wall invasion.