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Outcome of superior mesenteric-portal vein resection during pancreatectomy for borderline ductal adenocarcinoma: results of a prospective comparative study

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Abstract

Background

Approximately 20 % of patients affected by pancreatic ductal adenocarcinoma are amenable to surgical resection. Several tumours are reported as “borderline resectable” because of their proximity to the major vessels. In the effort to achieve a radical tumour removal, vein resection has been proposed, but its oncological benefits remain debated.

Methods

Our aim is to investigate morbidity, mortality and survival after pancreatectomy with vein resection.

Results

Forty patients underwent pancreatectomy and vein resection (group A), and 20 patients (group B) underwent bilio-enteric and/or gastro-entero bypass. In group A, cancer vein invasion was microscopically proven in 14 cases (35 %). Vein infiltration, tumour differentiation and node-positive disease were not adverse prognostic variables. No difference in survival was seen over a 1-year follow-up. After this period, group A showed significant survival benefits with a longer stabilisation of the disease (p = 0.005). Tumour-free resection margins and adjuvant chemoradiotherapy were the most important prognostic factors (p < 0.05).

Conclusions

Suspicion of vein infiltration should not be a contraindication to resection. Pancreatectomy can be safely performed with an acceptable morbidity and better survival trend.

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Acknowledgments

Written informed consent was obtained for publication of clinical data.

Conflicts of interest

The authors declare that they have no competing interests.

Author contributions

FS1, GM2 and CB2 analysed the data and wrote the manuscript. FS1 and CC1 participated in the acquisition and interpretation of statistical data. FS1, DD2, GM2 and CB2 contributed to the final version and carried out the clinical report. DD2, MM2, RS2 and GB2 contributed with technical help and general support. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Surgery, “G. d’Annunzio” University, Chieti-Pescara, Italy

    Federico Selvaggi & Carlo Cellini

  2. Department of Surgery and Oncology, Istituto del Pancreas “G.B. Rossi” Hospital, University of Verona, Verona, Italy

    Giuseppe Mascetta, Despoina Daskalaki, Marco dal Molin, Roberto Salvia, Giovanni Butturini & Claudio Bassi

  3. Department of Surgery and Oncology, Policlinico “GB Rossi”, University of Verona, P.Le L.A. Scuro, 10, 37134, Verona, Italy

    Claudio Bassi

Authors
  1. Federico Selvaggi
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  2. Giuseppe Mascetta
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  3. Despoina Daskalaki
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  4. Marco dal Molin
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  5. Roberto Salvia
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  7. Carlo Cellini
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  8. Claudio Bassi
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Correspondence to Claudio Bassi.

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Selvaggi, F., Mascetta, G., Daskalaki, D. et al. Outcome of superior mesenteric-portal vein resection during pancreatectomy for borderline ductal adenocarcinoma: results of a prospective comparative study. Langenbecks Arch Surg 399, 659–665 (2014). https://doi.org/10.1007/s00423-014-1194-6

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  • DOI: https://doi.org/10.1007/s00423-014-1194-6

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