Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival

Bell, R.; Ao, Braden Te; Ironside, Natasha; Bartlett, Adam; Windsor, John A.; Pandanaboyana, Sanjay

doi:10.1016/j.suronc.2016.12.007

Cited by 36 publications

(42 citation statements)

References 47 publications

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“…The SMA, the most common site of a positive margin following pancreatoduodenectomy, is often the last and most challenging to dissect, typically after division of the neck of the pancreas. Even in patients undergoing portal vein resection there is a relatively high margin‐positive resection rate along the SMA margin (27–100 per cent). The artery‐first approach to pancreatoduodenectomy was first described in 1993, in which the SMA was approached from the mesentery of the jejunum (mesenteric approach), allowing early division of the inferior pancreatoduodenal artery and subsequent meticulous dissection along its borders.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival

Ironside

Barreto

Loveday

et al. 2018

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival

Ironside

Barreto

Loveday

et al. 2018

British Journal of Surgery

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“…Initially, some studies did not show any significant differences in morbidity and mortality rates between patients with pancreatectomies with and without venous resection (3,13). However, more recent data including metaanalyses have shown increased mortality rates (18,24,25) and morbidity rates (18,25) when a venous resection is performed with pancreatectomy. The reported mortality rates after pancreatectomies with venous resection vary between 0% and 14% (12).…”

Section: Discussionmentioning

confidence: 99%

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Dumitraşcu¹,

Martiniuc²,

Brasoveanu³

et al. 2018

chr

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Invasion of portal vein (PV)/ superior mesenteric vein (SMV) in pancreatic ductal adenocarcinoma (PDAC) is no longer a contraindication for resection when reconstruction is technically feasible. However, the literature data reached conflicting conclusions regarding the early and long-term outcomes of patients with venous resection and pancreatectomies for PDAC. The study aims to present the outcomes in a large series of patients with pancreatectomies and associated PV/ SMV resection for PDAC, in a single center experience. The data of 100 patients with pancreatectomies and PV and/ or SMV resection performed between 2002 and 2016 (February, 1st) were retrospectively analyzed from a prospectively maintained electronic database, which included 474 pancreatectomies for PDAC. Only patients with a final pathological diagnosis of PDAC were included in the present study. Overall, 21.1% of patients with pancreatectomies for PDAC required a venous resection (100 patients out of 474 patients). Segmental resection was performed in 77 patients (out of 100 patients with pancreatectomies and venous resection - 77%), while 23 patients (23%) have had tangential venous resection. In the group of patients with segmental venous resection, reconstruction was made by end-to-end anastomosis in 53 patients (out of 77 patients - 68.8%), while in 24 patients (out of 77 patients - 31.2%) a graft interposition was necessary. Negative resections margins were obtained in 63 patients (63%). Histological tumor invasion of the resected vein was confirmed in 64 patients (64%). Postoperative complications occurred in 47 patients (47%), with severe complications (i.e., Dindo-Clavien grade III-V) in 19 patients (19%). Postoperative pancreatic fistulae, delayed gastric emptying and post-pancreatectomy hemorrhage rates were 9%, 20% and 15%, respectively. PV/ SMV thrombosis occurred in 5 patients (5%). The 90-day mortality rate in the group of patients with venous only resection, without any associated procedures, was 8%. Adjuvant treatment was performed in 63 patients (63%), while only 2 patients (2%) underwent neoadjuvant chemotherapy. Median follow-up time was 105 months (range, 3 - 186 months), with a median overall survival time of 13 months (range, 3 - 186 months). In the group of patients with negative resection margins, the median overall survival time was 16 months (range, 3 - 186 months). PV/ SMV resection during pancreatectomies for PDAC is technically feasible, and grafts are rarely required for venous reconstruction. However, venous resection is associated with high postoperative complications rates, and the mortality rate is not neglectable. The main goal of such complex procedure is to obtain negative resection margins, a situation associated with encouraging survival rates.

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“…К аналогичным выводам пришли R. Bell и соавт. [19] на основании изучения 4145 ПДР по поводу рака головки ПЖ, из которых у 1207 потребовалась резекция МПС. Послеоперационная летальность (6% vs. 4%) и частота нерадикальных операций (37% vs. 32%), пятилетняя выживаемость (3% vs. 8%; p=0,002) были достоверно ниже в группе с резекцией вены.…”

Section: рис 4 рентгенологические критерии погранично резектабельноunclassified

Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion

Кригер

Kаrmаzаnovsky

Smirnov

et al. 2018

Khir. Z. im. N.I. Pirogova

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Злокачественные опухоли поджелудочной железы (ПЖ) представляют непростой диагностический объект и являются сложной задачей для хирургического лечения. У значительной части больных, на момент установления диагноза, отсутствует возможность радикального лечения (наличие отдаленных метастазов, обширное местное распространение), а у некоторых-возможность радикального удаления опухоли дискутабельна. Исходя из материалов, опубликованных в книге «Состояние онкологической помощи населению Рос

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Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival

Cited by 36 publications

References 47 publications

Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival

Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion

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