Journal of Gastrointestinal Surgery

, Volume 17, Issue 7, pp 1209–1217

Vein Involvement During Pancreaticoduodenectomy: Is There a Need for Redefinition of “Borderline Resectable Disease”?

  • Kaitlyn J. Kelly
  • Emily Winslow
  • David Kooby
  • Neha L. Lad
  • Alexander A. Parikh
  • Charles R. Scoggins
  • Syed Ahmad
  • Robert C. Martin
  • Shishir K. Maithel
  • H. J. Kim
  • Nipun B. Merchant
  • Clifford S. Cho
  • Sharon M. Weber
2012 SSAT Plenary Presentation

Abstract

Introduction

Current National Comprehensive Cancer Network guidelines recommend neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma to increase the likelihood of achieving R0 resection. A consensus has not been reached on the degree of venous involvement that constitutes borderline resectability. This study compares the outcome of patients who underwent pancreaticoduodenectomy with or without vein resection without neoadjuvant therapy.

Methods

A multi-institutional database of patients who underwent pancreaticoduodenectomy was reviewed. Patients who required vein resection due to gross vein involvement by tumor were compared to those without evidence of vein involvement.

Results

Of 492 patients undergoing pancreaticoduodenectomy, 70 (14 %) had vein resection and 422 (86 %) did not. There was no difference in R0 resection (66 vs. 75 %, p = NS). On multivariate analysis, vein involvement was not predictive of disease-free or overall survival.

Conclusion

This is the largest modern series examining patients with or without isolated vein involvement by pancreas cancer, none of whom received neoadjuvant therapy. Oncological outcome was not different between the two groups. These data suggest that up-front surgical resection is an appropriate option and call into question the inclusion of isolated vein involvement in the definition of “borderline resectable disease.”

Keywords

Borderline resectable pancreas cancer Vein involvement Pancreatic adenocarcinoma Pancreaticoduodenectomy 

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Kaitlyn J. Kelly
    • 1
  • Emily Winslow
    • 1
  • David Kooby
    • 2
  • Neha L. Lad
    • 2
  • Alexander A. Parikh
    • 3
  • Charles R. Scoggins
    • 4
  • Syed Ahmad
    • 5
  • Robert C. Martin
    • 4
  • Shishir K. Maithel
    • 2
  • H. J. Kim
    • 6
  • Nipun B. Merchant
    • 3
  • Clifford S. Cho
    • 1
  • Sharon M. Weber
    • 1
    • 7
  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA
  2. 2.Department of SurgeryEmory UniversityAtlantaUSA
  3. 3.Department of SurgeryVanderbilt UniversityNashvilleUSA
  4. 4.Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  5. 5.Department of SurgeryUniversity of CincinnatiCincinnatiUSA
  6. 6.Department of SurgeryUniversity of North CarolinaChapel HillUSA
  7. 7.University of Wisconsin Hospital and ClinicsMadisonUSA

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