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. 2015 Aug 22:15:100.
doi: 10.1186/s12893-015-0086-1.

Outcomes of resections for pancreatic adenocarcinoma with suspected venous involvement: a single center experience

Christoph W Michalski  1   2 , Bo Kong  1 , Carsten Jäger  1 , Silke Kloe  1 , Barbara Beier  1 , Rickmer Braren  3 , Irene Esposito  4   5 , Mert Erkan  1   6 , Helmut Friess  1 , Jorg Kleeff  7
Affiliations

Outcomes of resections for pancreatic adenocarcinoma with suspected venous involvement: a single center experience

Christoph W Michalski et al. BMC Surg. .

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) patients frequently present with borderline resectable disease, which can be due to invasion of the portal/superior mesenteric vein (PV/SMV). Here, we analyzed this group of patients, with emphasis on short and long-term outcomes.

Methods: 156 patients who underwent a resection for PDAC were included in the analysis and sub-stratified into a cohort of patients with PV/SMV resection (n = 54) versus those with standard surgeries (n = 102).

Results: While venous resections could be performed safely, there was a trend towards shorter median survival in the PV/SMV resection group (22.7 vs. 15.8 months, p = 0.157). These tumors were significantly larger (3.5 vs. 4.3 cm; p = 0.026) and margin-positivity was more frequent (30.4% vs. 44.4%, p = 0.046).

Conclusion: Venous resection was associated with a higher rate of margin positivity and a trend towards shorter survival. However, compared to non-surgical treatment, resection offers the best chance for long term survival.

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Figures

Fig. 1
Fig. 1
Inclusion and exclusion criteria. Flow-chart of inclusion and exclusion criteria. The prospective database was retrospectively searched according to the criteria as described in the Methods section. Two cohorts of patients were defined: short- and long-term survivors and patients on whom standard resections or resections with vein resections were performed
Fig. 2
Fig. 2
Survival analysis. a, Survival according to the UICC stages was assessed using the Kaplan-Meier method and the log rank test. The overall p-value is 0.001. b, Survival in the patient groups with standard (no venous resection, NVR) and with venous resection (VR) was compared using Kaplan-Meier curves and the log rank test; p = 0.157. c, Survival according to different operative techniques was assessed using Kaplan-Meier curves and the log rank test. TP: total pancreatectomy; DP: distal pancreatectomy; pp-Whipple: partial, pylorus-preserving pancreaticoduodenectomy; cl-Whipple: “classical” Whipple, partial pancreaticoduodenectomy. d, Comparisons between the following groups were done using the Kaplan-Meier method and log rank testing: G1/2 without vein resection (a), G1/2 with vein resection (b), G3 without vein resection (c), G3 vein resection (d). The overall p-value is <0.001. a vs c: p < 0.001; b vs d: p = 0.023
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References

    1. Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254(6):882–893. doi: 10.1097/SLA.0b013e31823ac299. - DOI - PubMed
    1. Zhou Y, Zhang Z, Liu Y, Li B, Xu D. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg. 2012;36(4):884–891. doi: 10.1007/s00268-012-1461-z. - DOI - PubMed
    1. Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, et al. Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg. 2001;25(8):1002–1005. doi: 10.1007/s00268-001-0070-z. - DOI - PubMed
    1. Boggi U, Del Chiaro M, Croce C, Vistoli F, Signori S, Moretto C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery. 2009;146(5):869–881. doi: 10.1016/j.surg.2009.04.029. - DOI - PubMed
    1. Wang J, Estrella JS, Peng L, Rashid A, Varadhachary GR, Wang H, et al. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer. 2012;118(15):3801–3811. doi: 10.1002/cncr.26717. - DOI - PMC - PubMed

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