Benefit of venous resection for ductal adenocarcinoma of the pancreatic head

Hartel, Mark; Niedergethmann, Marco; Farag-Soliman, Michael; Sturm, J.; Richter, Α.; Trede, M.; Post, Stefan

doi:10.1080/00000000000000007

Cited by 68 publications

(89 citation statements)

References 14 publications

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“…[12][13][14][15]17,[27][28][29][30] This higher rate of postoperative complications did not translate into an increased length of hospital stay; overall, we found no significant difference in mortality between patients with and without VR, which is in agreement with most of the previous literature. 12,14,15,17,[28][29][30][31] Only 1 previous study, in which no difference in overall in-hospital mortality was found, reported higher 30-day mortality among patients who underwent concomitant VR. 27 A recent systematic review and meta-analysis, focused only on arterial resections, also found increased mortality rates among patients who underwent VR compared with pancreatectomy alone.…”

Section: Commentsupporting

confidence: 82%

Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease

Worni¹,

Castleberry²,

Clary³

et al. 2013

JAMA Surg

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Objective: To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR.Design: Single-center series have been conducted to evaluate the short-term and long-term outcomes of VR during pancreatic resection. However, its effectiveness from a population-based perspective is still unknown. Unadjusted, multivariable, and propensity score-adjusted generalized linear models were performed. Patients who underwent pancreatic resection with VR were at a higher risk for intraoperative (propensity score-adjusted odds ratio, 1.94; P=.001) and postoperative (propensity score-adjusted odds ratio, 1.36; P=.008) complications, while the mortality and median length of hospital stay were similar to those of patients without VR. Among the 25% of hospitals with the highest surgical volume, patients who underwent pancreatic surgery with VR had significantly higher rates of postoperative complications and mortality than patients without VR. Conclusions:The frequency of VR during pancreatic surgery is increasing in the United States. In contrast with most single-center analyses, this population-based study demonstrated that patients who underwent VR during pancreatic surgery had higher rates of adverse postoperative outcomes than their counterparts who underwent pancreatic resection only. Prospective studies incorporating long-term outcomes are warranted to further define which patients benefit from VR.

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Section: Commentsupporting

confidence: 82%

Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease

Worni¹,

Castleberry²,

Clary³

et al. 2013

JAMA Surg

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“…Hartel et al, examined outcomes between their cohort of patients (n=271) who underwent pancreaticoduodenectomy +/− major vein resection. Their analysis revealed no difference in the rates of perioperative morbidity, mortality, and 5-year survival between the two groups [14]. Similar results were observed by Tseng et al, at MD Anderson Cancer Center for their patients who underwent pancreaticoduodenectomy with major vascular resection.…”

Section: Extended Pancreaticoduodenectomy With Major Vascular Resectionsupporting

confidence: 73%

“…In this report, the operation performed depended on the location of the tumor within the pancreas, and included pylorus-preserving pancreaticoduodenectomy, classic Whipple pancreaticoduodenectomy, total pancreatectomy, distal pancreatectomy, and subtotal pancreatectomy. Traditionally, as with pancreatic adenocarcinoma, PNET vascular involvement was considered a contraindication to resection, however based on the experience previously reviewed regarding adenocarcinoma [14,15,17], resection of these locally advanced, and even metastatic tumors was undertaken. Of the patients described above, 4 had PV or SMV involvement and all received complete resection of their tumor with vascular reconstruction by vein patch, vein graft, or synthetic graft.…”

Section: Radical Resections For Pancreatic Neuroendocrine Tumorsmentioning

confidence: 99%

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Schoellhammer

Goldner

Kim

et al. 2013

Indian J Surg Oncol

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Pancreatic adenocarcinoma is the most common pancreatic malignancy, and it occurs most commonly in the pancreatic head. It has a relatively low incidence; however it is a deadly disease and is the fourth most common cause of cancer deaths for males and females in the United States. Surgical resection in the form of pancreaticoduodenectomy is the mainstay of treatment and can lead to improved overall survival as well as the possibility of a cure, although only 10 % of patients are resectable at presentation. In an attempt to improve outcomes and survival, surgeons over the decades have employed various aggressive resectional strategies to combat this disease. In this paper we review the development of pancreaticoduodenectomy and touch on the role played by the American surgeon Allan Whipple in this development. We review modern data regarding radical pancreaticoduodenectomy and extended lymphadenectomy for pancreatic head cancers, as well as data and controversies regarding arterial and venous resection performed during the course of pancreaticoduodenectomy. The role of extended and vascular resections in the treatment of pancreatic neuroendocrine tumors in contrast to adenocarcinomas is also examined. We summarize the current state of data regarding radical pancreaticoduodenectomy and discuss pushing the boundaries of surgical resection to help improve outcomes for select groups of patients.

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“…There are no prospective randomized trials comparing pancreatectomy with and without VnR. Most retrospective studies demonstrate that while VnR is associated with longer operative times and larger blood loss, the morbidity and mortality of pancreatectomy with VnR is similar to those of pancreatectomy alone (Table 3) [42][43][44][45][46][47][48][49][50][51][52][53][54]. There was a high incidence of venous invasion (50%-82%) among patients who underwent VnR.…”

Section: Portal/mesenteric Vascular Resectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the evidence in favor of and against the role of surgical resection in the management of pancreatic adenocarcinoma.2. Explain how the components of an extended pancreatectomy, including total pancreatectomy, extended lymph node dissection, and major intestinal arterial resection, do not improve survival above what is provided after pancreaticoduodenectomy and are associated with substantial morbidity.3. Discuss how portal/mesenteric vein resection to achieve negative resection margins does not add to the morbidity of pancreaticoduodenectomy, does not worsen survival after resection, and is most often performed because of tumor location.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAdenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

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Benefit of venous resection for ductal adenocarcinoma of the pancreatic head

Abstract: There is no reason to exclude patients with suspected venous infiltration from radical pancreaticoduodenectomy including venous resection.

Cited by 68 publications

References 14 publications

Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease

Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Extended Resection for Pancreatic Adenocarcinoma

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