Venous resection during pancreatectomy for pancreatic cancer: a systematic review

Wang, Xiaobo; Demir, Ihsan Ekin; Schorn, Stefan; Jäger, Carsten; Scheufele, Florian; Frieß, Helmut; Ceyhan, Güralp O.

doi:10.21037/tgh.2019.06.01

Cited by 22 publications

(17 citation statements)

References 61 publications

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“…It is unquestionable that venous resection during PD must also aim to obtain negative resection margins, while the reported effects on survival remain controversial [ 61 ]. A meta-analysis showed that pancreatectomy combined with venous resection needed longer operative time and had increased perioperative blood loss compared to the group of pancreatectomy without venous resection [ 62 ]. Patients with venous resection attained reduced R0 rates.…”

Section: Surgerymentioning

confidence: 99%

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Wei

Hackert

2021

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor of the digestive system with still low five-year survival of less than 10%. Although there are improvements for multimodal therapy of PDAC, surgery still remains the effective way to treat the disease. Combined with adjuvant and/or neoadjuvant treatment, pancreatic surgery is able to enhance the five-year survival up to around 20%. However, pancreatic resection is always associated with a high risk of complications and regarded as one of the most complex fields in abdominal surgery. This review gives a summary on the surgical treatment for PDAC based on the current literature with a special focus on resection techniques.

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Section: Surgerymentioning

confidence: 99%

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Wei

Hackert

2021

Cancers

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“…On the other hand, as a strong argument for the topographic hypothesis, complete tumor removal is one of the most important prognostic factors for long-term survival. 36 Interestingly, Mierke et al 37 analyzed recurrence patterns after PDAC resection with VRR. They observed that despite en bloc vascular resection, the true pathologic invasion of SMV/PV constitutes an independent risk factor for OS and DFS, noting a higher incidence of liver metastasis compared with the absence of SMV/PV infiltration.…”

Section: The Role Of Nat Is Emerging But Still Under Explorationmentioning

confidence: 99%

What Should Guide the Performance of Venous Resection During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma with Venous Contact?

et al. 2021

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Complete surgical resection, most often associated with perioperative chemotherapy, is the only way to offer a chance of cure for patients with pancreatic cancer. One of the most important factors in determining survival outcome that can be influenced by the surgeon is the R0 resection. However, the proximity of mesenteric vessels in cephalic pancreatic tumors, especially the mesenterico-portal venous axis, results in an increased risk of vein involvement and/or the presence of malignant cells in the venous bed margin. A concomitant venous resection can be performed to decrease the risk of a positive margin. Given the additional technical difficulty that this implies, many surgeons seek a path between the tumor and the vein, hoping for the absence of tumor infiltration into the perivascular tissue on pathologic analysis, particularly in cases with administration of neoadjuvant therapy. The definition of optimal surgical margin remains a subject of debate, but at least 1 mm is an independent predictor of survival after pancreatic cancer surgical resection. Although preoperative radiologic assessment is essential for accurate planning of a pancreatic resection, intraoperative decision-making with regard to resection of the mesenterico-portal vein in tumors with a venous contact remains unclear and variable. Although venous histologic involvement and perivascular infiltration are not accurately predictable preoperatively, clinicians must examine the existing criteria and normograms to guide their surgical management according to the integration of new imaging techniques, preoperative chemotherapy use, tumor biology and molecular histopathology, and surgical techniques.

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“…Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease, and the five-year survival rate is lower than 8% (1)(2)(3). Although surgery remains the only potential chance for a cure, some patients with localized PDAC are not appropriated for upfront surgery or even unresectable due to the involvement of peripancreatic vessels (3)(4)(5)(6)(7)(8). Regarding patients with peripancreatic arterial involvement, upfront surgery is known to be associated with a low resection rate and a deteriorated long-term survival (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Regarding patients with peripancreatic arterial involvement, upfront surgery is known to be associated with a low resection rate and a deteriorated long-term survival (4,5). In contrast, for patients with isolated peripancreatic venous [portal vein-superior mesenteric vein (PV-SMV)] involvement, long-term survival after extended pancreaticoduodenectomy (PD) with venous resection may be comparable to that achieved by standard PD without venous resection (6)(7)(8). However, the determination of surgical PV-SMV invasion is still based on intraoperative diagnosis (9).…”

Section: Introductionmentioning

confidence: 99%

“…However, the determination of surgical PV-SMV invasion is still based on intraoperative diagnosis (9). Preoperative knowledge of PV-SMV invasion status can promote adequate preoperative preparation, which may mitigate the positive margins associated with unplanned PV-SMV resection, decrease unresectable events due to the inexperience of extended PD, and reduce surgery-related complications (6)(7)(8)10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiomics-Assisted Presurgical Prediction for Surgical Portal Vein-Superior Mesenteric Vein Invasion in Pancreatic Ductal Adenocarcinoma

Chen

Zhou

et al. 2020

Front. Oncol.

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Objectives To develop a radiomics signature for predicting surgical portal vein-superior mesenteric vein (PV-SMV) in patients with pancreatic ductal adenocarcinoma (PDAC) and measure the effect of providing the predictions of radiomics signature to radiologists with different diagnostic experiences during imaging interpretation. Methods Between February 2008 and June 2020, 146 patients with PDAC in pancreatic head or uncinate process from two institutions were retrospectively included and randomly split into a training (n = 88) and a validation (n =58) cohort. Intraoperative vascular exploration findings were used to identify surgical PV-SMV invasion. Radiomics features were extracted from the portal venous phase CT images. Radiomics signature was built with a linear elastic-net regression model. Area under receiver operating characteristic curve (AUC) of the radiomics signature was calculated. A senior and a junior radiologist independently review CT scans and made the diagnosis for PV-SMV invasion both with and without radiomics score (Radscore) assistance. A 2-sided Pearson’s chi-squared test was conducted to evaluate whether there was a difference in sensitivity, specificity, and accuracy between the radiomics signature and the unassisted radiologists. To assess the incremental value of providing Radscore predictions to the radiologists, we compared the performance between unassisted evaluation and Radscore-assisted evaluation by using the McNemar test. Results Numbers of patients identified as presence of surgical PV-SMV invasion were 33 (37.5%) and 19 (32.8%) in the training and validation cohort, respectively. The radiomics signature achieved an AUC of 0.848 (95% confidence interval, 0.724–0.971) in the validation cohort and had a comparable sensitivity, specificity, and accuracy as the senior radiologist in predicting PV-SMV invasion (all p -values > 0.05). Providing predictions of radiomics signature increased both radiologists’ sensitivity in identifying PV-SMV invasion, while only the increase of the junior radiologist was significant (63.2 vs 89.5%, p -value = 0.025) instead of the senior radiologist (73.7 vs 89.5%, p -value = 0.08). Both radiologists’ accuracy had no significant increase when provided radiomics signature assistance (both p -values > 0.05). Conclusions The radiomics signature can predict surgical PV-SMV invasion in patients with PDAC and may have incremental value to the diagnostic performance of radiologists during imaging interpretation.

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Venous resection during pancreatectomy for pancreatic cancer: a systematic review

Cited by 22 publications

References 61 publications

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

What Should Guide the Performance of Venous Resection During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma with Venous Contact?

Radiomics-Assisted Presurgical Prediction for Surgical Portal Vein-Superior Mesenteric Vein Invasion in Pancreatic Ductal Adenocarcinoma

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