Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 730–736 | Cite as

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

  • Franz Mierke
  • Sebastian Hempel
  • Marius Distler
  • Daniela E. Aust
  • Hans-Detlev Saeger
  • Jürgen Weitz
  • Thilo Welsch
Gastrointestinal Oncology

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 PI. 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 (PI). The study revealed differences in overall median survival (11.9 [P+I+] vs. 16.1 [P+I] vs. 20.1 [PI] 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 % [PI], 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 [PI]). 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.

Keywords

Overall Survival Pancreatic Ductal Adenocarcinoma Lymph Node Ratio Tumor Infiltration Circumferential Resection Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

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

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 21.
    Esposito I, Kleeff J, Bergmann F, et al. Most pancreatic cancer resections are R1 resections. Ann Surg Oncol. 2008;15(6):1651-60.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Franz Mierke
    • 1
  • Sebastian Hempel
    • 1
  • Marius Distler
    • 1
  • Daniela E. Aust
    • 2
  • Hans-Detlev Saeger
    • 1
  • Jürgen Weitz
    • 1
  • Thilo Welsch
    • 1
  1. 1.Department of Visceral, Thoracic and Vascular SurgeryUniversity Hospital Carl Gustav Carus, TU DresdenDresdenGermany
  2. 2.Institute for PathologyUniversity Hospital Carl Gustav Carus, TU DresdenDresdenGermany

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