Vascular invasion in pancreatic cancer: Tumor biology or tumor topography?

Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer

“…The SMV groove was also more likely to be positive in these patients and this may be related to a greater area of venous involvement requiring a larger resection. The tumour size was no different, in keeping with the postulate that venous involvement is a matter of topography and not an indicator of more aggressive tumour biology.…”

“…However, this did not have a negative impact on median overall survival (20⋅8, 21⋅3 and 13⋅3 months in patients with superficial, deep or no histological vein involvement respectively; P = 0⋅111). Although some other studies 6,31 have also shown no correlation between venous tumour involvement and overall survival, others 8 -10,20,32 have demonstrated venous tumour invasion to be a negative prognostic indicator associated with poorer overall survival. In a retrospective analysis 9 of 100 patients who underwent portal vein resection, 77 with venous tumour infiltration and 23 without, median survival was 15 and 16 months respectively; however, no differentiation of the depth of involvement was made.…”

Opportunities of improvement in the management of pancreatic and periampullary tumors

“…Improvements of local clearance have been reported by other centers after vascular resection without neoadjuvant chemotherapy [12], and resected patients experience prolonged survival together with improved patient reported quality of life during the first 2 years after diagnosis [28]. A recent report support the hypothesis that vascular invasion above all is an indicator of unfavorable topography, rather than a robust parameter for adverse tumor biology [29]. …”

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

“…1. The invasion of the common hepatic artery (CHA) or the gastroduodenal artery (GDA) at its origin, of the superior mesenteric artery (SMA), or the celiac axis (CA) is usually considered as a contraindication for resection due to the risks of both morbidity and mortality, and poor oncological results (56,(110)(111)(112)(113) The report from the French Association of Surgery (41) (2004-2009) showed that in France AR was performed during pancreatectomy for PDAC in 2% of cases (37/1670, 27 + VR) with a morbidity rate of 54%, a 30-day mortality rate of 8% and a 3-year survival rate of 8% (median: 12.7 months, median survival rate without recurrence, 7 months). In a VR study in this series, AR significantly increased mortality (RR = 2.09; 95% CI = 0.99-4.38; p = 0.05) (LE 4).…”