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Adverse Tumor Biology Associated with Mesenterico-Portal Vein Resection Influences Survival in Patients with Pancreatic Ductal Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.

Patients and Methods

Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD−VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.

Results

Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD−VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD−VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD−VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.

Conclusions

PD with VR has similar morbidity but worse OS compared with a PD−VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.

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Acknowledgment

The authors acknowledge Mrs Jen Arena for updating the database, Associate Professor Mark Sywak, Association Professor Andrew Kneebone, and Associate Professor Alex Guminski for their contribution to the manuscript.

Disclosure

The authors declare no conflicts of interest in presenting this manuscript.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, St Leonards, NSW, Australia

    F. Wang MClinEpid, FRACS, S. Gananadha MS, FRACS, T. J. Hugh MD, FRACS & J. S. Samra DPhil, FRACS

  2. Department of Anatomical Pathology, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, St Leonards, NSW, Australia

    A. J. Gill MD, FRACP

  3. Department of Vascular Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, St Leonards, NSW, Australia

    M. Neale MM, FRACS & V. Puttaswamy MBBS, FRACS

  4. Department of Medical Oncology, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, St Leonards, NSW, Australia

    N. Pavlakis PhD, FRACP & S. Clarke MD, FRACP

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  1. F. Wang MClinEpid, FRACS
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  2. A. J. Gill MD, FRACP
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  3. M. Neale MM, FRACS
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  4. V. Puttaswamy MBBS, FRACS
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  6. N. Pavlakis PhD, FRACP
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  8. T. J. Hugh MD, FRACS
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  9. J. S. Samra DPhil, FRACS
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Correspondence to J. S. Samra DPhil, FRACS.

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Wang, F., Gill, A.J., Neale, M. et al. Adverse Tumor Biology Associated with Mesenterico-Portal Vein Resection Influences Survival in Patients with Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 21, 1937–1947 (2014). https://doi.org/10.1245/s10434-014-3554-4

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  • DOI: https://doi.org/10.1245/s10434-014-3554-4

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