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

Annals of Surgical Oncology volume 23, pages 730–736 (2016)Cite this article

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 P−I−. 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 (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.

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.

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Acknowledgments

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

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Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Franz Mierke, Sebastian Hempel MD, Marius Distler MD, Hans-Detlev Saeger MD, Jürgen Weitz MD & Thilo Welsch MD

  2. Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Daniela E. Aust MD

Authors
  1. Franz Mierke
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  2. Sebastian Hempel MD
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  3. Marius Distler MD
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  4. Daniela E. Aust MD
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  5. Hans-Detlev Saeger MD
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  6. Jürgen Weitz MD
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  7. Thilo Welsch MD
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Correspondence to Thilo Welsch MD.

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Mierke, F., Hempel, S., Distler, M. et al. Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection. Ann Surg Oncol 23, 730–736 (2016). https://doi.org/10.1245/s10434-016-5515-6

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  • DOI: https://doi.org/10.1245/s10434-016-5515-6

Keywords

  • Overall Survival
  • Pancreatic Ductal Adenocarcinoma
  • Lymph Node Ratio
  • Tumor Infiltration
  • Circumferential Resection Margin