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. 2025 Jan 22.
doi: 10.1097/SLA.0000000000006638. Online ahead of print.

Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome

Thomas F Stoop  1   2   3   4 , Adrienne Molnár  3   5 , Leonard W F Seelen  6 , Toshitaka Sugawara  3   7 , Jacobien C M Scheepens  6 , Mahsoem Ali  2   8 , Ammar A Javed  1   2   9 , Asif Halimi  5 , Atsushi Oba  7   10 , Bas Groot Koerkamp  11 , Bodil Andersson  12 , Caroline Williamsson  12 , Christopher L Wolfgang  9 , Daisuke Ban  7 , Ernesto Sparrelid  4 , Freek Daams  2   8 , Geert Kazemier  2   8 , Hjalmar C van Santvoort  6 , Ingmar F Rompen  1   2   11 , I Quintus Molenaar  6 , Joseph R Habib  9 , Lysanne P M Beuk  11 , Niek J Geerdink  1   2 , Roeland F de Wilde  11 , Olivier R Busch  1   2 , Oskar Swartling  4 , Paulina Bereza-Carlson  12 , Poya Ghorbani  4 , Reeve L Kruize  1   2 , Richard D Schulick  3 , Salvador Rodriguez Franco  3 , Tatsunori Miyata  10 , Oskar Franklin  3   5 , Yosuke Inoue  10 , Marc G Besselink  1   2 , Marco Del Chiaro  3 ; International Collaborative Group on Locally Advanced Pancreatic Cancer
Affiliations

Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome

Thomas F Stoop et al. Ann Surg. .

Abstract

Objective: To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement.

Summary background data: Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability.

Methods: International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders.

Results: Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]).

Conclusions: In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.

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Conflict of interest statement

Financial disclosure/conflicts of interest: (1) Marco Del Chiaro has been awarded an industry grant (Haemonetics, Inc) to conduct a multicenter study to evaluate the prognostic implications of TEG in pancreatic cancer. (2) Marco Del Chiaro is co-principal investigator of a Boston Scientific sponsored international multicenter study on the use of intraoperative pancreatoscopy of patients with IPMN. (3) Atsushi Oba has been awarded with a grant (Bayer Yakuhin, Ltd.) to conduct an observational study to investigate the clinical impact of EOB-MRI in pancreatic cancer. (4) Asif Halimi is consultant for Olympus with regard to organizing pancreas surgery courses.

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