Reconsideration about the aggressive surgery for resectable pancreatic cancer: a focus on real pathological portosplenomesenteric venous invasion

Okabayashi, Takehiro; Shima, Yasuo; Iwata, Jun; Morita, Sojiro; Sumiyoshi, Tatsuaki; Kozuki, Amane; Saisaka, Yuichi; Tokumaru, Teppei; Iiyama, Tatsuo; Noda, Yoshifumi; Hata, Yasuhiro; Matsumoto, Manabu

doi:10.1007/s00423-015-1305-z

Cited by 20 publications

(10 citation statements)

References 27 publications

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“…Seven studies reported comparison of the clinicopathologic features between patients with and without histopathologic SMV/PV invasion [4, 7, 10, 13, 18–20]. Pooled analysis showed that patients with SMV/PV invasion had higher rates of poor tumor differentiation ( P = 0.002), lymph node metastasis ( P < 0.001), perineural invasion ( P < 0.001), positive resection margins ( P = 0.004), and postoperative tumor recurrence ( P < 0.001) as compared with patients without SMV/PV invasion, including those who underwent pancreatectomy without SMV/PV resection (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Song

Liu

et al. 2017

Oncotarget

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BackgroundThe impact of histopathologic tumor invasion of the superior mesenteric vein (SMV)/portal vein (PV) on prognosis in patients with pancreatic ductal adenocarcinoma (PDAC) after pancreatectomy remains controversial. A meta-analysis was performed to assess this issue.ResultsEighteen observational studies comprising 5242 patients were eligible, of whom 2199 (41.9%) patients received SMV/PV resection. Histopathologic tumor invasion was detected in 1218 (58.1%) of the 2096 resected SMV/PV specimens. SMV/PV invasion was associated with higher rates of poor tumor differentiation (P = 0.002), lymph node metastasis (P < 0.001), perineural invasion (P < 0.001), positive resection margins (P = 0.004), and postoperative tumor recurrence (P < 0.001). SMV/PV invasion showed a significantly negative effect on survival in total patients who underwent pancreatectomy with and without SMV/PV resection (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.08–1.35; P = 0.001) and in patients who underwent pancreatectomy with SMV/PV resection (HR: 1.88, 95% CI, 1.48–2.39; P < 0.001).Materials And MethodsA systematic literature search was performed to identify articles published from January 2000 to August 2016. Data were pooled for meta-analysis using Review Manager 5.3.ConclusionsHistopathologic tumor invasion of the SMV/PV is associated with more aggressive biologic behavior and could be used as an indicator of poor prognosis after PDAC resection.

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Section: Resultsmentioning

confidence: 99%

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Song

Liu

et al. 2017

Oncotarget

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“…Data from the last 5 years examining arterial resection for curative surgical intent for PDAC have changed compared to the past 20 years ago. Interestingly, many centers are reporting 5-year survival rates (around 20%) for patients who undergo arterial resection, which is improved compared to the previous results, reaching, in selected cases and after NAT, 53 months of median survival (Table 3) (2, 15, 24, 37, 75–86).…”

Section: Pancreatectomies Associated With Artery (±Vein) Resections Amentioning

confidence: 87%

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

et al. 2020

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Background and Aims: It has become clear that vein resection and reconstruction for pancreatic ductal adenocarcinoma (PDAC) is the standard of care as supported by multiple guidelines. However, resection of large peri-pancreatic arteries remains debatable. Materials and Methods: This review examines the current state of vascular resection with curative intent for PDAC in the last 5 years. Herein, we consider venous (superior mesenteric vein, portal vein), as well as arterial (superior mesenteric artery, celiac trunk, hepatic artery) resection or both with or without reconstruction. Results: Improvement of multidrug chemotherapy has revolutionized care for PDAC that should shift traditional surgical thinking from an anatomical classification of resectability to a prognostic and biological classification. Conclusion: The present review gives an overview on the results of pancreatectomy associated with vascular resection, with consideration of new perspectives offered by the availability of better systemic therapies.

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“…A multicenter study conducted in Italy found that pathological MPV invasion ( P = 0.0052) and adjuvant chemotherapy ( P = 0.0041) were significantly associated with prognosis[6]. Okabayashi et al[14] found that the incidence of postoperative peritoneal dissemination and the accumulative rate of recurrence at 2 years after surgery in the MPV+ group were higher than those in the MPV- group. Therefore, it has been proven that combined MPV resection is a safe surgical technique[11-13].…”

Section: Discussionmentioning

confidence: 99%

Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8^th edition of the American Joint Committee on Cancer staging system

Chen

Wang

Zhang

et al. 2019

WJG

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BACKGROUNDThe 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC) excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein (MPV) invasion into T1-3 diseases according to tumor size. However, MPV invasion is believed to be correlated with a poor prognosis.AIMTo analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for PDAC.METHODSThis study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival outcomes. In the first cohort, a total of 7539 patients in the surveillance, epidemiology, and end results database was included, and in the second cohort, 689 patients from the West China Hospital database were enrolled.RESULTSCox regression analysis showed that MPV invasion is an independent prognostic factor in both databases. In the MPV- group, all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage IIB. However, in the MPV+ group, pairwise comparisons between the survival functions of patients with stage IA, stage IB, stage IIA, stage IIB, and stage III were not significant. T1-3N0 patients in the MPV+ group were compared with the T1N0, T2N0, and T3N0 subgroups of the MPV- group; only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant difference. Further comparisons of patients with stage IIA and subgroups of stage IIB showed (1) no significant difference between the survival of T2N1 and T3N0 patients; (2) a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients; and (3) and a shorter survival of T3N1 patients that was similar to that of T1-3N2 patients.CONCLUSIONThe modified 8th edition of the AJCC staging system for PDAC proposed in this study, which includes the factor of MPV invasion, provides improvements in predicting prognosis, especially in MPV+ patients.

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Reconsideration about the aggressive surgery for resectable pancreatic cancer: a focus on real pathological portosplenomesenteric venous invasion

Cited by 20 publications

References 27 publications

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8^th edition of the American Joint Committee on Cancer staging system

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Reconsideration about the aggressive surgery for resectable pancreatic cancer: a focus on real pathological portosplenomesenteric venous invasion

Cited by 20 publications

References 27 publications

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8th edition of the American Joint Committee on Cancer staging system

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Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8^th edition of the American Joint Committee on Cancer staging system