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The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence

Journal of Gastrointestinal Cancer volume 51, pages 379–386 (2020)Cite this article

Abstract

Purpose

The prognostic significance of portal/superior mesenteric vein (PV/SMV) invasion at the time of pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) is contentious. The aim of this meta-analysis was to compare the survival outcomes in patients with histologically proven adventitial (superficial) versus media/intimal (deep) PV/SMV invasion at the time of PD for PDAC.

Methods

A systematic search of the PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. All articles reporting outcomes specific to the depth of PDAC invasion into the PV/SMV wall were included. The primary outcome measure was overall survival.

Results

Six studies including 310 patients who underwent pancreatic resection with PV/SMV resection for PDAC were included in this meta-analysis. There was no difference in overall survival comparing superficial vs deep invasion at 12 months (64% vs 58% respectively, risk difference, − 0.09; CI, − 0.21–0.04; P = 0.183), 36 months (22% vs 18% respectively, risk difference, − 0.05; CI, − 0.16–0.19; P = 0.857) and mean overall survival (42.8 months vs 25.7 months respectively, standard mean difference, − 0.27; CI, − 0.58, 0.03; P = 0.078). Although larger tumours were seen in those with confirmed deep vein wall invasion (P < 0.001), no difference was observed between the superficial and deep invasion groups with regard to age (P = 0.298), R1 resection (P = 0.896), nodal metastatic disease (P = 0.120) and perineural invasion (P = 0.609).

Conclusions

This meta-analysis suggests that the depth of PV/SMV wall invasion by PDAC may not impact survival after PD. However, given the limited sample size, further research is warranted with homogenous cohorts and longer follow-up.

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Author information

Affiliations

  1. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Chathura B. B. Ratnayake & John A Windsor

  2. HPB unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand

    Chathura B. B. Ratnayake & John A Windsor

  3. Department of HPB Surgery, Northern General Hospital, Sheffield, UK

    Nehal Shah

  4. Department of HPB Surgery, Royal Melbourne Hospital, Melbourne, Australia

    Benjamin Loveday

  5. HPB and Transplant Unit, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK

    Sanjay Pandanaboyana

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  1. Chathura B. B. Ratnayake
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  2. Nehal Shah
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Correspondence to Sanjay Pandanaboyana.

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Ratnayake, C.B.B., Shah, N., Loveday, B. et al. The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence. J Gastrointest Canc 51, 379–386 (2020). https://doi.org/10.1007/s12029-019-00248-3

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  • DOI: https://doi.org/10.1007/s12029-019-00248-3

Keywords

  • Pancreatoduodenectomy
  • Pancreatic cancer
  • Porto-mesenteric vein
  • Vein wall invasion