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. 2017 Sep 12;8(44):77883-77896.
doi: 10.18632/oncotarget.20847. eCollection 2017 Sep 29.

Portal vein resection and reconstruction with artificial blood vessels is safe and feasible for pancreatic ductal adenocarcinoma patients with portal vein involvement: Chinese center experience

Zhi-Bo Xie #  1 , Ji-Chun Gu #  1 , Yi-Fan Zhang #  2 , Lie Yao  1 , Chen Jin  1 , Yong-Jian Jiang  1 , Ji Li  1 , Feng Yang  1 , Cai-Feng Zou  1 , De-Liang Fu  1
Affiliations

Portal vein resection and reconstruction with artificial blood vessels is safe and feasible for pancreatic ductal adenocarcinoma patients with portal vein involvement: Chinese center experience

Zhi-Bo Xie et al. Oncotarget. .

Abstract

Evidence shows that portal vein resection (PVR) increase the resectability but does little benefit to overall survival in all pancreatic ductal adenocarcinoma (PDAC) patients. But for patients with portal vein involvement, PVR is the only radical choice. But whether the PDAC patients with portal vein involvement would benefit from radical pancreaticoduodenectomy with PVR or not is controversial. All 204 PDAC patients with portal vein involvement were enrolled in this study [PVR group, n=106; surgical bypass (SB) group, n=52; chemotherapy group, n=46]. Overall survival and prognostic factors were analyzed among three groups. Moreover, a literature review of 13 studies were also conducted. Among 3 groups, patients in PVR group achieved a significant longer survival (median survival: PVR group, 22.83 months; SB group, 7.26 months; chemotherapy group, 10.64 months). Therapy choice [hazard ratio (HR) =1.593, 95% confidence interval (CI) 1.323 to 1.918, P<0.001], body mass index (HR=0.772, 95% CI 0.559 to 0.994, P=0.044) and carbohydrateantigen 19-9 (HR=1.325, 95% CI 1.064 to 1.651, P=0.012) were independent prognostic factors which significantly affected overall survival. Pancreaticoduodenectomy combined with PVR and reconstruct with artificial blood vessels is a safe and an appropriate therapy choice for resectable PDAC patients with portal vein involvement.

Keywords: artificial blood vessels; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; portal vein involvement; portal vein resection.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors disclose no conflicts of interest.

Figures

Figure 1
Figure 1. Survivals difference in all pancreatic ductal adenocarcinoma patients
(A) Survivals difference in patients with different therapy. (B) Survivals difference in patients with different carbohydrateantigen 19-9 levels. (C) Survivals difference in patients with different body mass index.
Figure 2
Figure 2. Survivals difference in pancreatic ductal adenocarcinoma patients with portal vein resection
(A) Survivals difference in patients with or without portal vein invasion. (B) Survivals difference in patients with different body mass index. (C) Survivals difference in patients with different carbohydrateantigen 19-9 levels. (D) Survivals difference in patients with or without lymph node metastasis.
Figure 3
Figure 3. Selection flow
Notes: From 2010 to 2015, 1382 potential eligible PDAC patients were enrolled in this study. Altogether 209 patients satisfied the inclusion and exclusion criteria (PVR group, n=111; SB group, n=50; chemo group, n=46). Three patients in PVR group were found liver metastasis during intraoperative exploration and were excluded. Tumors of two patients in PVR group were without the ability of reconstruction, thus undergoing SB procedure and were divided into SB group. Finally 204 eligible PDCA patients were enrolled (PVR group, n=106; SB group, n=52; chemo group, n=46).
Figure 4
Figure 4. Schema of surgical procedures
(A) CT scan of PDAC patients with PV involvement. (B) Surgical procedure of PD combined with PVR. (C) Sketch map of PD combined with PVR. Abbreviation: CT= Computer tomography, PD= pancreaticoduodenectomy, PDAC= pancreatic ductal adenocarcinoma, PV= Portal vein, PVR=Portal vein resection.
See this image and copyright information in PMC

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