Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection
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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.
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 P−I−. Statistical analysis was performed using the R software package.
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 (P−I−). The study revealed differences in overall median survival (11.9 [P+I+] vs. 16.1 [P+I−] vs. 20.1 [P−I−] 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 % [P−I−], 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 [P−I−]). Initial liver metastases occurred in 33 % of the patients.
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.
KeywordsOverall Survival Pancreatic Ductal Adenocarcinoma Lymph Node Ratio Tumor Infiltration Circumferential Resection Margin
The authors thank Cody Tippie for his dedicated proof reading and revision of the manuscript.
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