Venous thrombosis following pancreaticoduodenectomy with venous resection

Mohammed, Somala; Mendez-Reyes, Jose E.; McElhany, Amy L.; Gonzales-Luna, Daniel; Buren, George Van; Bland, Daniel S.; Villafañe-Ferriol, Nicole; Pierzynski, Jeanne A.; West, Charles A.; Silberfein, Eric J.; Fisher, William E.

doi:10.1016/j.jss.2018.02.006

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…Furthermore, the morbidity and mortality rate is not different from that reported for “conventional pancreatectomies.” Interestingly, 13 out of 43 papers published in the past 5 years report a mortality rate below 1% (Table 1). Survival data were available in a limited number of studies; however, even there, the 5-year survival rate varies from 0% to 39%, which is not different from studies published for pancreatectomy without vein resection (17–59). The overall picture as demonstrated in Table 1 shows that vein resections are commonly done in experienced centers, and that short- and long-term results are comparable with these of “conventional” pancreatic surgery.…”

Section: Pancreatectomies Associated With Vein Resections and Reconstmentioning

confidence: 90%

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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Section: Pancreatectomies Associated With Vein Resections and Reconstmentioning

confidence: 90%

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

et al. 2020

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“…In many studies, the rate of R1 resection is indeed higher after pancreatectomy with VRR than after standard pancreatectomy, whereas the median survival is decreased (Table 3). 35,55,62,63,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] A French Association of Surgery study compared outcomes between patients undergoing pancreaticoduodenectomy with or without VRR and observed a significantly reduced median survival (21 vs 29 months; p = 0.0002) after VRR, possibly related to more advanced and aggressive disease. 35 Interestingly, in this group, NAT administration tended to improve the prognosis.…”

Section: Outcomes After Pancreatectomy With Venous Resectionmentioning

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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“…PD with vascular resection is performed in anywhere from 13% to 30% of PD cases at high-volume centers. 24,26,29,30 Even for those radiologically classified with resectable disease, up to 30% of these patients display vascular involvement intraoperatively. 29,30 Vascular resection is safely achievable with little difference in perioperative morbidity but has been associated with worse long-term outcomes such as decreased overall survival (OS) and increased rates of disease recurrence compared to standard PD.…”

Section: Introductionmentioning

confidence: 99%

“…29,30 Vascular resection is safely achievable with little difference in perioperative morbidity but has been associated with worse long-term outcomes such as decreased overall survival (OS) and increased rates of disease recurrence compared to standard PD. 24,26,29,30 With this study, we sought to understand the differences in short-term and longterm outcomes of patients undergoing PD with vascular resection depending on the receipt of NAC versus surgery upfront with adjuvant chemotherapy. We hypothesized that NAC would be associated with improved short-term perioperative and long-term oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Although NAC has been increasingly scrutinized recently, few studies have yet characterized the effects of NAC on those undergoing pancreaticoduodenectomy (PD) with vascular resection specifically 4–29 . PD with vascular resection is performed in anywhere from 13% to 30% of PD cases at high‐volume centers 24,26,29,30 . Even for those radiologically classified with resectable disease, up to 30% of these patients display vascular involvement intraoperatively 29,30 .…”

Section: Introductionmentioning

confidence: 99%

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Neoadjuvant chemotherapy is associated with improved disease‐free survival in pancreatic cancer patients undergoing pancreaticoduodenectomy with vascular resection

Dillon,

Park,

Mederos

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesNeoadjuvant chemotherapy (NAC) is becoming favored for all pancreatic adenocarcinoma (PDAC). Patients with seemingly resectable disease infrequently still display vascular involvement intraoperatively. Outcomes following NAC versus upfront surgery in patients undergoing pancreaticoduodenectomy (PD) with vascular resection are unknown.MethodsWe performed a retrospective cohort study of PDAC patients who underwent PD with vascular resection between January 1, 2013, to December 31, 2020, within a single academic center. Clinicopathologic characteristics and disease‐free survival (DFS) were compared between NAC versus upfront surgery cohorts using the Kaplan–Meier estimate and Cox proportional‐hazards regression model.ResultsEighty‐one patients who underwent PD with vascular resection for PDAC were included. Forty‐six patients (56%) received NAC. The NAC cohort more often had pathologic N0 status (47.8% vs. 8.6%, p < 0.001), had decreased vascular invasion (11% vs. 40%, p = 0.002), and completed chemotherapy (80% vs. 40%, p < 0.01). The NAC cohort demonstrated improved DFS (40.5 vs. 14.3 months, p = 0.007). In multivariable analysis, NAC remained independently associated with increased DFS (HR = 0.48, p = 0.02).ConclusionsNAC was associated with improved clinicopathologic outcomes and DFS in PD with vascular resection. These findings demonstrate the advantage of NAC in PDAC patients undergoing PD with vascular resection.

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Venous thrombosis following pancreaticoduodenectomy with venous resection

Cited by 9 publications

References 16 publications

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC

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

Neoadjuvant chemotherapy is associated with improved disease‐free survival in pancreatic cancer patients undergoing pancreaticoduodenectomy with vascular resection

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