Survival of pancreaticoduodenectomies with venous reconstruction using a population-based database.

Abstract

340 Background: Locally advanced disease requiring pancreaticoduodenectomy (PD) with venous reconstruction is a controversial topic that is often determined by careful patient selection. There are numerous published single institution, but sparse multicenter studies, demonstrating the safety and efficacy of PD with venous reconstruction. The goal of this study is to evaluate survival outcomes in patients who underwent a PD with our without venous reconstruction utilizing a large statewide database. Methods: The California Cancer Registry (CCR) was used to obtain data on all PD performed from 2000-2011. This data was merged with Office of Statewide Planning and Development data to obtain inpatient hospitalization data. ICD-09 codes were used to identify all PD with or without venous reconstruction. Data was obtained on demographics, disease process, surgery, hospitalization statistics, and survival. Venous reconstruction was divided into venous segmental resection with reconstruction (VSR) and primary repair of the vein with a patch (PR). Survival was analyzed using Kaplan-Meier Survival analysis (KM). Results: Data were obtained on 5,228 patients who underwent PD, 3.7% (161) underwent venous reconstruction (148; 2.8% VSR and 43; 0.8% PR). A significant overall survival difference between PD and all vascular reconstruction was observed (23 months vs 17 months respectively, p < 0.001). Further analysis revealed no significant difference in survival between standard PD and PD with PR (median 21 months; p = 0.2). However, there was a significant survival advantage of PD compared to PD with VSR (21 vs 16 months respectively, p < 0.001). Evaluation of length of stay and complications revealed no statistical difference (p = 0.07 and p = 0.8). Conclusions: Venous reconstruction in PD is associated with worse survival compared to PD alone. Interestingly, patients who had a PR had a better survival than VSR alone. Overall survival for all comers of vascular reconstruction remains inferior which reinforces the biology of disease as an important predictor of outcomes as well as shorter segment portal vein involvement conferring improved survival.

Case of successful treatment of recurrent duodenal gastrointestinal stromal tumor invading the inferior vena cava

“…), где было проанализировано 5228 ПДР, выполненных с 2000 по 2011 г. Из них 161 ПДР была выполнена с резекцией магистральных сосу-дов. Авторы выявили существенную разницу в общей выживае-мости между стандартной ПДР и ПДР с резекцией магистраль-ных сосудов (23 мес против 17 мес, p<0,001) [11]. В исследовании Н. Yamaue и соавт.…”

“…Инвазию опухоли в магистральные сосуды выявляют у 40% первично диагностируемых больных с ОБПДЗ [2,3,11].…”