Significance of Portal Vein Invasion and Extent of Invasion in Patients Undergoing Pancreatoduodenectomy for Pancreatic Adenocarcinoma

Roch, Alexandra M.; House, Michael G.; Cioffi, Jessica; Ceppa, Eugene P.; Zyromski, Nicholas J.; Nakeeb, Attila; Schmidt, C. Max

doi:10.1007/s11605-015-3005-y

Cited by 38 publications

(34 citation statements)

References 23 publications

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“…The median overall survival of the 142 patients included in the study was 17 months (range 1 -144 months), which is comparable to the results of Roch et al [44]. Patients that underwent PD tend to have a longer median survival than those with simultaneous venous resection, but without statistical significance.…”

Section: Discussionsupporting

confidence: 78%

Pancreatoduodenectomy with Simultaneous Venous Resection for Advanced Ductal Pancreatic Head Cancer: A Case Control Study

Scherber¹,

Mikneviciute²,

Gäbelein³

et al. 2018

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Introduction: Surgical resection is the treatment of choice for pancreatic ductal adenocarcinoma (PDA). However, in case of venous tumor involvement, carcinomas are classified as borderline resectable and their preferential therapy remains controversial. The purpose of this study is to analyze the effectiveness of the surgical approach with simultaneous venous resection regarding perioperative outcome and long-term survival. Patients and methods: All patients that underwent pancreatoduodenectomy (PD) for PDA at our institution between 02/2002 and 12/2016 were analyzed retrospectively. A matched-pair analysis between patients that underwent PD with simultaneous venous resection (PDVR) and standard PD was performed to compare perioperative parameters, survival and factors relevant to long-term survival. Results: The study included 142 patients: 71 underwent PDVR and 71 underwent standard PD. Venous tumor infiltration could histopathologically be confirmed in 21 patients (29.58%). PDVR wasn't associated with a higher rate of postoperative complications (56.34% for both groups), severe postoperative complications (28.17% vs. 23.94%) and mortality (5.63% vs. 9.86%) compared to standard PD. Median overall survival of both groups was 17 months (95% CI 10.89-23.11), without statistical significance between the two groups (PD 22 months, 95% CI 16.02-27.99 vs. PDVR 16 months, 95% CI 9.96-22.04, p = 0.087). Parameters associated with overall survival were histopathologically proven venous tumor infiltration, the lymph node status and the necessity of postoperative blood transfusions. Conclusion: PDVR is justified, because peri-and post-operative morbidity and mortality, as well as long-term survival, are comparable to standard PD. Even in case of postoperatively histopathologically confirmed venous tumor infiltration, patients benefit over palliative treatment.

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Section: Discussionsupporting

confidence: 78%

Pancreatoduodenectomy with Simultaneous Venous Resection for Advanced Ductal Pancreatic Head Cancer: A Case Control Study

Scherber¹,

Mikneviciute²,

Gäbelein³

et al. 2018

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“…Although lymph node metastasis was a significant prognostic factor in many studies, including the present study, the optimal extent of lymphadenectomy for PDAC remains to be defined. Fortner performed very wide ‘regional’ lymphadenectomy, including the retroperitoneal para‐aortic and coeliac axis lymph nodes, in their original RP.…”

Section: Discussionmentioning

confidence: 80%

Regional pancreatoduodenectomy versus standard pancreatoduodenectomy with portal vein resection for pancreatic ductal adenocarcinoma with portal vein invasion

Oba

Ito

et al. 2020

BJS Open

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Background: Pancreatoduodenectomy (PD) with portal vein resection (PVR) is a standard operation for pancreatic ductal adenocarcinoma (PDAC) with portal vein (PV) invasion, but positive margin rates remain high. It was hypothesized that regional pancreatoduodenectomy (RPD), in which soft tissue around the PV is resected en bloc, could enhance oncological clearance and survival.Methods: This retrospective study included consecutive patients who underwent PD with PVR between January 2005 and December 2016 in a single high-volume centre. In standard PD (SPD) with PVR, the PV was skeletonized and the surrounding soft tissue dissected. In RPD, the retropancreatic segment of the PV was resected en bloc with its surrounding soft tissue. The extent of lymphadenectomy was similar between the procedures.Results: A total of 268 patients were included (177 SPD, 91 RPD). Tumours were more often resectable in patients undergoing SPD (60⋅5 per cent versus 38 per cent in those having RPD; P = 0⋅014), and consequently they received neoadjuvant therapy less often (7⋅9 versus 25 per cent respectively; P < 0⋅001). R0 resection was achieved in 73 patients (80 per cent) in the RPD group, compared with 117 (66⋅1 per cent) of those in the SPD group (P = 0⋅016), although perioperative outcomes were comparable between the groups. Median recurrence-free (RFS) and overall (OS) survival were 17 and 32 months respectively in patients who had RPD, compared with 11 and 21 months in those who had SPD (RFS: P = 0⋅003; OS: P = 0⋅004).Conclusion: RPD is as safe and feasible as SPD, and may increase the survival of patients with PDAC with PV invasion.

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“…6.4. The extent of tumor invasion (grades 1: adventitia, 2: media, and 3: intima) described by Nakao (18) is often poorly evaluated and the prognostic value of this feature is also debated (82,87,89,90,93), including after neoadjuvant treatment (92, 94) (LE 4). In the series by Roch et al (93), the 3 grades of tumor invasion had no significant impact on overall or disease-free survival (14.4 vs. 15.5 vs. 7.4 months, p = 0.08 and 11.2 vs. 12.2 vs. 5 months, p = 0.59, respectively), although survival was very short in case of intra-luminal tumor invasion (however, the number of patients was low) (LE 4).…”

Section: Impact Of the Reconstruction Technique On The Long-term Permmentioning

confidence: 99%

Vascular Resection for Pancreatic Cancer: 2019 French Recommendations Based on a Literature Review From 2008 to 6-2019

Delpero

Sauvanet

2020

Front. Oncol.

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Significance of Portal Vein Invasion and Extent of Invasion in Patients Undergoing Pancreatoduodenectomy for Pancreatic Adenocarcinoma

Cited by 38 publications

References 23 publications

Pancreatoduodenectomy with Simultaneous Venous Resection for Advanced Ductal Pancreatic Head Cancer: A Case Control Study

Pancreatoduodenectomy with Simultaneous Venous Resection for Advanced Ductal Pancreatic Head Cancer: A Case Control Study

Regional pancreatoduodenectomy versus standard pancreatoduodenectomy with portal vein resection for pancreatic ductal adenocarcinoma with portal vein invasion

Vascular Resection for Pancreatic Cancer: 2019 French Recommendations Based on a Literature Review From 2008 to 6-2019

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