Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Abstract

Background Microvascular invasion (MVI) has been proved to be poor prognostic factor in many cancers. To date, only one study published highlights the relationship between this factor and the natural history of pancreatic cancer. The aim of this study was to assess the impact of MVI, on disease‐free survival (DFS) and overall survival (OS), after pancreatico‐duodenectomy (PD) for pancreatic head adenocarcinoma. Secondarily, we aim to demonstrate that MVI is the most important factor to predict OS after surgery compared with resection margin (RM) and lymph node (LN) status. Materials and Methods Between January 2015 and December 2017, 158 PD were performed in two hepato‐bilio‐pancreatic (HBP) centers. Among these, only 79 patients fulfilled the inclusion criteria of the study. Clinical‐pathological data and outcomes were retrospectively analyzed from a prospectively maintained database. Results Of the 79 patients in the cohort, MVI was identified in 35 (44.3%). In univariate analysis, MVI (P = .012 and P < .0001), RM (P = .023 and P = .021), and LN status (P < .0001 and P = .0001) were significantly associated with DFS and OS. A less than 1 mm margin clearance did not influence relapse (P = .72) or long‐term survival (P = .48). LN ratio > 0.226 had a negative impact on OS (P = .044). In multivariate analysis, MVI and RM persisted as independent prognostic factors of DFS (P = .0075 and P = .0098, respectively) and OS (P < .0001 and P = .0194, respectively). Using the likelihood ratio test, MVI was identified as the best fit to predict OS after PD for ductal adenocarcinomas compared with the margin status model (R0 vs R1) (P = .0014). Conclusion The MVI represents another major prognostic factor determining long‐term outcomes.

Prognostic factors for long-term survival after pancreaticoduodenectomy for periampullary adenocarcinoma. A retrospective cohort study

“…Despite several refinements in the surgical technique with the improvement of postoperative mortality, the long-term prognosis still disappointing with a 5-years survival rate rarely to exceed 20% in some centers. These results raised the enthusiasm to search for the main factors that can improve the prognosis of periampullary tumors with the optimal resection [ 1 , 4 , 6 , 12 ].…”

“…Zhao et al, reported in their study that the perineural infiltration was a significant prognostic factor after pancreatic head resection and has been proven to be related to local failure [ 37 ]. The perineural invasion appeared to be the most significantly associated with 1-year mortality [ 10 , 12 , 38 ]. In our study, the perineural invasion was significantly independent risk factors for poor OS.…”

“…Panaro et al, concluded that PDAC is considered a systemic disease, and microvascular invasion is a major prognostic factor after PD as it can lead to distant metastasis, but unfortunately, we cannot predict microvascular invasion in the preoperative image, so it raised the question about the significance of neoadjuvant therapy for all resectable pancreatic cancer, that needs further studies [ 12 ].…”

“…Several clinicopathological factors, such as tumor size, resection margin, cell differentiation, lymph node metastasis, perineural and perivascular invasion have been comprehensively studied for determining survival outcome after PD for periampullary cancers [ [7] , [8] , [9] ]. Lymphovascular invasion and perineural infiltration in the specimens post-Whipple were reported to be associated with reduced 5-year survival in patients with PAAC [ [10] , [11] , [12] ].…”

“…Pancreaticoduodenectomy surgery is associated with high morbidity and mortality, therefore it is important to determine which patient can receive benefits from surgery to avoid unnecessary intervention and to facilitate treatment planning of neoadjuvant and adjuvant treatments [ 12 , 13 ]. This study aimed to investigate the prognostic factors for long-term survival in resectable PAAC.…”