The impact of venous resection in pancreatoduodectomy

Abstract

Background: Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial. Objective: This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD). Methods: A systematic review and meta-analysis of studies comparing VRPD and PD were performed. Results: VRPD was associated with a higher risk for postoperative mortality (risk difference: −0.01; 95% confidence interval [CI] −0.02 to −0.00) and complications (risk difference: −0.05; 95% CI −0.09 to −0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: −0.65; 95% CI −2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: −69.09; 95% CI −88.4 to −49.78), with a higher blood loss rate (MD: −314.04; 95% CI −423.86 to −195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03–1.23). Conclusion: VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection

“… 47 - 51 Compared with pancreatic resection alone, adding SMV-PV resection significantly increased 30-day postoperative mortality, 47 , 50 but not 90-day mortality, 51 morbidity, 47 , 50 the rates of certain complications, 48 , 51 the length of hospital stay, 48 or the proportion of non-radical resections. 47 - 51 Long-term survival was also significantly shorter for patients undergoing SMV-PV resection. 47 , 49 - 51 …”

“… 47 - 51 Long-term survival was also significantly shorter for patients undergoing SMV-PV resection. 47 , 49 - 51 …”

“…[47][48][49][50][51] Compared with pancreatic resection alone, adding SMV-PV resection significantly increased 30-day postoperative mortality, 47,50 but not 90-day mortality, 51 morbidity, 47,50 the rates of certain complications, 48,51 the length of hospital stay, 48 or the proportion of non-radical resections. [47][48][49][50][51] Long-term survival was also significantly shorter for patients undergoing SMV-PV resection. 47,[49][50][51] An interesting comparison can be drawn between the benchmarks targeting surgical performance, morbidity, mortality, and oncological parameters in patients undergoing PD or PD plus SMV-PV resection, based on data collected by 23 international centers expert in pancreatic surgery (Table 1).…”

A more radical perspective on surgical approach and outcomes in pancreatic cancer—a narrative review

“…In high-volume centers, type 2 PD with venous resection of the portomesenteric veins is expected to account for at least 15% of pancreatic resections (63). Recent meta-analysis reinforces that venous resection is associated with worse short-term outcomes, such as increased blood loss, perioperative morbidity and higher positive margins as well as lower long-term survival (64,65). Although high heterogeneity and different levels of center experience will always be an inherent challenge in this type of comparison.…”

Vascular Resection in Pancreatectomy—Is It Safe and Useful for Patients with Advanced Pancreatic Cancer?

“…A recent meta-analysis by Filho et al [ 52 ] confirmed that PDVR was associated with a higher risk for postoperative morbidity and mortality, longer duration of hospitalization, and higher blood loss as well as a worse OS compared with standard PD.…”