One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Abstract

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.

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

“…An associated portal/superior mesenteric vein resection was reported in about 25-26% of patients with PD and concurrent colectomies [26,27]. Similar venous resection rates are reported during standard PD for PDAC in many western centers [14,64]. However, a few studies found statistically significant higher rates of venous resection in patients with PD and concurrent colectomies (particularly for PDAC) compared with standard PD: 32% vs. 13% (p = 0.007) [30]; 25% vs. 15%, (p < 0.001) [27].…”

“…However, a few studies found statistically significant higher rates of venous resection in patients with PD and concurrent colectomies (particularly for PDAC) compared with standard PD: 32% vs. 13% (p = 0.007) [30]; 25% vs. 15%, (p < 0.001) [27]. A venous resection during PD may increase the perioperative complications rates and harm long-term survival [14,64]. However, a recent meta-analysis found similar overall morbidity, mortality, and survival rates in patients with pancreatectomies with and without venous resections [65].…”

Nomogram for Predicting Overall Survival of Metastatic Pancreatic Cancer Patients based on Inflammatory- Nutritional Biomarkers and HBV Infection

“…Several studies suggest that HBV infection contributes to the occurrence and progression of pancreatic cancer. 21,22 However, whether such infection in uences prognosis in pancreatic cancer remains controversial. For example, HBV infection was associated in one study with higher risk of synchronous liver metastases and therefore worse prognosis.…”

“…( 21) However, another study found no signi cant difference in short-or long-term survival between HBV-positive or -negative patients following pancreatic cancer resection. (22) This discrepancy may re ect differences in the patient samples. Future research should explore the relationship between mPC patients and OS by Further large sample and multi-center studies.…”