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Pancreatectomy with Mesenteric and Portal Vein Resection for Borderline Resectable Pancreatic Cancer: Multicenter Study of 406 Patients

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The role of pancreatectomy with en bloc venous resection and the prognostic impact of pathological venous invasion are still debated. The authors analyzed perioperative, survival results, and prognostic factors of pancreatectomy with en bloc portal (PV) or superior mesenteric vein (SMV) resection for borderline resectable pancreatic carcinoma, focusing on predictive factors of histological venous invasion and its prognostic role.

Methods

A multicenter database of 406 patients submitted to pancreatectomy with en bloc SMV and/or PV resection for pancreatic adenocarcinoma was analyzed retrospectively. Univariate and multivariate analysis of factors related to histological venous invasion were performed using logistic regression model. Prognostic factors were analyzed with log-rank test and multivariate proportional hazard regression analysis.

Results

Complications occurred in 51.9 % of patients and postoperative death in 7.1 %. Histological invasion of the resected vein was confirmed in 56.7 % of specimens. Five-year survival was 24.4 % with median survival of 24 months. Vein invasion at preoperative computed tomography (CT), N status, number of metastatic lymph nodes, preoperative serum albumin were related to pathological venous invasion at univariate analysis, and vein invasion at CT was independently related to venous invasion at multivariate analysis. Use of preoperative biliary drain was significantly associated with postoperative complications. Multivariate proportional hazard regression analysis demonstrated a significant correlation between overall survival and histological venous invasion and administration of adjuvant therapy.

Conclusions

This study identifies predictive factors of pathological venous invasion and prognostic factors for overall survival, including pathological venous invasion, which may help with patients’ selection for different treatment protocols.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit, Rome, Italy

    Giovanni Ramacciato MD, Giuseppe Nigri MD & Niccolò Petrucciani MD

  2. Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, General Surgery and Transplantation Unit, Bologna, Italy

    Antonio Daniele Pinna MD & Matteo Ravaioli MD

  3. General Surgery Unit, ‘Maggiore’ Hospital, Bologna, Italy

    Elio Jovine MD

  4. Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, S. Orsola-Malpighi Hospital, University of Bologna, General Surgery Unit, Bologna, Italy

    Francesco Minni MD

  5. Regina Elena National Cancer Institute IFO, Hepato-pancreato-biliary Surgery Unit, Rome, Italy

    Gian Luca Grazi MD

  6. Department of Surgical Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, General Surgery Unit, Rome, Italy

    Piero Chirletti MD

  7. Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy

    Giuseppe Tisone MD

  8. Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy

    Niccolò Napoli MD & Ugo Boggi MD

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  1. Giovanni Ramacciato MD
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Correspondence to Giuseppe Nigri MD.

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Ramacciato, G., Nigri, G., Petrucciani, N. et al. Pancreatectomy with Mesenteric and Portal Vein Resection for Borderline Resectable Pancreatic Cancer: Multicenter Study of 406 Patients. Ann Surg Oncol 23, 2028–2037 (2016). https://doi.org/10.1245/s10434-016-5123-5

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  • DOI: https://doi.org/10.1245/s10434-016-5123-5

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