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Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection

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

Abstract

Background

The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection.

Methods

Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P+) and pathohistological PV/SMV tumor infiltration (I+): P+I+, P+I−, and P−I−. Statistical analysis was performed using the R software package.

Results

The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P+I+), and were matched with 66 cases without PV/SMV infiltration (P−I−). The study revealed differences in overall median survival (11.9 [P+I+] vs. 16.1 [P+I−] vs. 20.1 [P−I−] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P+I+] vs. 45.8 % [P+I−] vs. 54.7 % [P−I−], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P+I+] vs. 10.9 months [P+I−] vs. 11.6 months [P−I−]). Initial liver metastases occurred in 33 % of the patients.

Conclusions

True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.

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References

  1. Quaresma M, Coleman MP, Rachet B. 40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study. Lancet Lond Engl. 2015;385(9974):1206-18.

    Article  Google Scholar 

  2. Bold RJ, Charnsangavej C, Cleary KR, et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg. 1999;3(3):233-43.

    Article  CAS  PubMed  Google Scholar 

  3. Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308(2):147-56.

    Article  CAS  PubMed  Google Scholar 

  4. Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155(6):977-88.

    Article  PubMed  Google Scholar 

  5. Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247(2):300-09.

    Article  PubMed  Google Scholar 

  6. Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg. 2006;10(8):1106-15.

    Article  PubMed  Google Scholar 

  7. Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg. 2009;13(4):784-92.

    Article  PubMed  Google Scholar 

  8. Turrini O, Ewald J, Barbier L, Mokart D, Blache JL, Delpero JR. Should the portal vein be routinely resected during pancreaticoduodenectomy for adenocarcinoma? Ann Surg. 2013;257(4):726-30.

    Article  PubMed  Google Scholar 

  9. Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I. Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg. 2016;103(3):179-91.

    Article  CAS  PubMed  Google Scholar 

  10. Yu XZ, Li J, Fu DL, et al. Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis. Eur J Surg Oncol. 2014;40(4):371-78.

    Article  CAS  PubMed  Google Scholar 

  11. Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35(6):600-04.

    Article  PubMed  Google Scholar 

  12. Zhou Y, Zhang Z, Liu Y, Li B, Xu D. Pancreatectomy combined with superior mesenteric vein–portal vein resection for pancreatic cancer: a meta-analysis. World J Surg. 2012;36(4):884-91.

    Article  PubMed  Google Scholar 

  13. Ravikumar R, Sabin C, Abu Hilal M, et al. Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg. 2014;218(3):401-11.

    Article  PubMed  Google Scholar 

  14. Beltrame V, Gruppo M, Pedrazzoli S, Merigliano S, Pastorelli D, Sperti C. Mesenteric-portal vein resection during pancreatectomy for pancreatic cancer. Gastroenterol Res Pract. 2015;2015:659730.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bissolati M, Sandri MT, Burtulo G, Zorzino L, Balzano G, Braga M. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer. Tumour Biol. 2015;36(2):991-96.

    Article  CAS  PubMed  Google Scholar 

  16. Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg. 2013;257(4):731-36.

    Article  PubMed  Google Scholar 

  17. Matsuda Y, Hagio M, Naito Z, Ishiwata T. Clinicopathological features of 30 autopsy cases of pancreatic carcinoma. J Nippon Med Sch. 2012;79(6):459-67.

    Article  PubMed  Google Scholar 

  18. Adham M, Mirza DF, Chapuis F, et al. Results of vascular resections during pancreatectomy from two European centres: an analysis of survival and disease-free survival explicative factors. HPB (Oxford). 2006;8(6):465-73.

    Article  CAS  Google Scholar 

  19. Katz MHG, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16(4):836-47.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kruger S, Haas M, Burger PJ, et al. Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer. Pancreatology. 2016;16(4):593–8. doi:10.1016/j.pan.2016.03.016.

    Article  PubMed  Google Scholar 

  21. Esposito I, Kleeff J, Bergmann F, et al. Most pancreatic cancer resections are R1 resections. Ann Surg Oncol. 2008;15(6):1651-60.

    Article  PubMed  Google Scholar 

  22. Hartwig W, Hackert T, Hinz U, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg. 2011;254(2):311-19.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Cody Tippie for his dedicated proof reading and revision of the manuscript.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Franz Mierke, Sebastian Hempel MD, Marius Distler MD, Hans-Detlev Saeger MD, Jürgen Weitz MD & Thilo Welsch MD

  2. Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Daniela E. Aust MD

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  1. Franz Mierke
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  2. Sebastian Hempel MD
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  3. Marius Distler MD
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  4. Daniela E. Aust MD
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  5. Hans-Detlev Saeger MD
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  6. Jürgen Weitz MD
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  7. Thilo Welsch MD
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Correspondence to Thilo Welsch MD.

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Mierke, F., Hempel, S., Distler, M. et al. Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection. Ann Surg Oncol 23 (Suppl 5), 730–736 (2016). https://doi.org/10.1245/s10434-016-5515-6

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  • DOI: https://doi.org/10.1245/s10434-016-5515-6

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