Prognostic factors after pancreatoduodenectomy with en bloc portal venous resection for pancreatic cancer
- First Online:
- 264 Downloads
Pancreatoduodenectomy (PD) with superior mesenteric/portal venous resection (PVR) for pancreatic ductal adenocarcinoma (PDAC) is performed routinely in case of tumor adhesion to the superior mesenteric or portal vein. True histopathological portal vein invasion (PVI) is found in a subgroup of patients. Even though this procedure has become routine in most centers for pancreatic surgery, data on prognostic factors in this situation is limited. The aim of this study was to identify prognostic factors after PD with PVR for PDAC.
Retrospective analysis was performed on the basis of a prospectively maintained database, and paraffin-embedded formalin-fixed tissue slides stained for hematoxylin-eosin were re-evaluated by two independent pathologists. Statistical analysis was conducted using MedCalc software.
From 2001 to 2012, 86 cases of PD with PVR for PDAC with long-term follow-up and sufficient tissue for re-assessment were identified. Histopathological re-review disclosed PVI in 39 resection specimens and adhesion without infiltration in 47. Overall median survival in all patients was 22 months. Patients with PVI versus no PVI showed comparable baseline demographic and standard histopathological parameters; however, PVI was associated with microscopic hemangiosis (p = 0.001) and positive margin status (p = 0.001). Median survival in patients with PVI was 14 months versus 25 months in patients without PVI (p = 0.042). Only lymph node ratio and PVI were independent predictors of survival after resection.
The only independent factors influencing overall survival after PD with PVR for PDAC were lymph node ratio and PVI. PVI might indicate aggressive tumor biology, but the available data remains controversial.
KeywordsPancreatic ductal adenocarcinoma Pancreatoduodenectomy Portal venous tumor infiltration Portal venous resection Median survival
- 7.Castleberry AW, White RR, De La Fuente SG et al (2012) The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Ann Surg Oncol 19:4068–4077. doi:10.1245/s10434-012-2585-y CrossRefPubMedGoogle Scholar
- 9.Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumors of the digestive system, 4th edn. International Agency for Research in Cancer, Lyon, FranceGoogle Scholar
- 13.Cao HST, Balachandran A, Wang H et al (2014) Radiographic tumor-vein interface as a predictor of intraoperative, pathologic and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract 18:269–278. doi:10.1007/s11605-013-2374-3 CrossRefGoogle Scholar
- 14.Gong Y, Zhang L, He T, et al. (2013) Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis. PLoS ONE. doi: 10.1371/journal.pone.0070340Google Scholar
- 18.Wang J, Estrella JS, Peng L et al (2012) Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 118:3801–3811. doi:10.1002/cncr.26717 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Yekebas EF, Bogoevski D, Cataldegirmen G et al (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 247:300–9. doi:10.1097/SLA.0b013e31815aab22 CrossRefPubMedGoogle Scholar