Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Abstract

SummaryIntroduction Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma. Patients and methods Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short-and long-term survival were assessed via multivariate logistic and Cox regression. Results Baseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66 was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10-3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31-3.58) were independent predictors. Conclusion Despite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.

Morbidity, mortality and long term survival in patients with vascular resection in pancreatic cancer – single center experience

“…According to our experience, in accordance with some recently published single center studies [9,10] the postoperative morbidity, mortality and long term survival is equal in patients with/without venous resections in the treatment of localized pancreatic cancer. Moreover the long term survival for the selected patient with PV-SMV resections after R0 resection followed with subsequent adjuvant chemotherapy is almost the same.…”

Distal Pancreatectomy En Bloc With Splenectomy, Celiac Axis and Portal Vein Resection Followed by Arterial Reconstruction Using a Cadaveric Graft – A Case Report and Literature Review

“…Therefore, patients submitted to standard pancreatic resections reported similar long-term outcomes when compared to cases submitted to pancreatic resections en bloc with portal vein resection. Moreover, in certain cases a benefit in terms of survival was also observed in selected cases submitted to concomitant arterial resection; therefore, the presence of arterial and venous invasion was no longer considered a formal contraindication for surgery (16)(17)(18)(19).…”

Impact factors for perioperative morbidity and mortality and repercussion of perioperative morbidity and long-term survival in pancreatic head resection

“…In our study, neither type of pancreatic resection nor the incidence of VMS/VP resection influenced the occurrence of postoperative morbidity and mortality. 47 – 52 …”