Skip to main content

Advertisement

SpringerLink
Log in

Is Pancreatic Head Cancer with Portal Venous Involvement Really Borderline Resectable? Appraisal of an Upfront Surgery Series

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

Abstract

Background

It remains controversial whether the degree of venous involvement really is associated with borderline resectability of pancreatic cancer.

Methods

A single-center retrospective review of patients who underwent upfront pancreaticoduodenectomy for T3 pancreatic cancer without arterial involvement was performed. The patients were classified as having resectable tumors without venous contact (R group), resectable tumors with venous contact of 180° or less (R-PV group), and borderline resectable tumors with venous contact greater than 180° (BR-PV group). The unresectable group included those who had unresected tumors with paraaortic lymph node metastasis, positive peritoneal lavage cytology, or locally advanced disease. The overall survival and prognostic factors were analyzed.

Results

The study enrolled 299 resected patients, including 141 patients in the R group, 119 patients in the R-PV group, and 39 patients in the BR-PV group. The overall survival did not differ significantly between the R-PV group and the BR-PV group (median survival, 20.7 vs 18.6 months; P = 0.807). Among the 158 patients who had tumors with venous contact, only a tumor size of 50 mm or larger (P = 0.041) was an independent prognostic factor in a multivariate analysis, and the overall survival for the patients with both venous contact and tumor size 50 mm or larger was comparable with that for the unresectable group (P = 0.547).

Conclusions

The degree of venous involvement may not be associated with the resectability of pancreatic head cancer, whereas tumors 50 mm in size or larger that develop venous invasion may be categorized as borderline resectable pancreatic cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–89.

    Article  PubMed  Google Scholar 

  2. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version 2.2017. http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 20 May 2017.

  3. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.

    Article  PubMed  Google Scholar 

  4. Katz MH, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–46.

    Article  PubMed  Google Scholar 

  5. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.

    Article  PubMed  Google Scholar 

  6. 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: 977–88.

    Article  PubMed  Google Scholar 

  7. Kato H, Usui M, Isaji S, et al. Clinical features and treatment outcome of borderline resectable pancreatic head/body cancer: a multi-institutional survey by the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20:601–10.

    Article  PubMed  Google Scholar 

  8. Takahashi H, Akita H, Tomokuni A, et al. Preoperative gemcitabine-based chemoradiation therapy for borderline resectable pancreatic cancer: impact of venous and arterial involvement status on surgical outcome and pattern of recurrence. Ann Surg. 2016;264:1091–7.

    Article  PubMed  Google Scholar 

  9. Murakami Y, Uemura K, Hashimoto Y, et al. Survival effects of adjuvant gemcitabine plus S-1 chemotherapy on pancreatic carcinoma stratified by preoperative resectability status. J Surg Oncol. 2016;113:405–12.

    Article  CAS  PubMed  Google Scholar 

  10. Kim EJ, Ben-Josef E, Herman JM, et al. A multi-institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. Cancer. 2013;119:2692–700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rose JB, Rocha FG, Alseidi A, et al. Extended neoadjuvant chemotherapy for borderline resectable pancreatic cancer demonstrates promising postoperative outcomes and survival. Ann Surg Oncol. 2014;21:1530–7.

    Article  PubMed  Google Scholar 

  12. Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261:12–7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ishikawa O, Ohigashi H, Imaoka S, et al. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg. 1992;215:231–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nakao A, Kanzaki A, Fujii T, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255:103–8.

    Article  PubMed  Google Scholar 

  15. Tran Cao HS, Balachandran A, Wang H, et al. Radiographic tumor-vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg. 2014;18:269–78.

    Article  PubMed  Google Scholar 

  16. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. Springer, New York, 2010.

    Google Scholar 

  17. Sugiura T, Uesaka K, Ohmagari N, Kanemoto H, Mizuno T. Risk factor of surgical-site infection after pancreaticoduodenectomy. World J Surg. 2012;36:2888–94.

    Article  PubMed  Google Scholar 

  18. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.

    Article  CAS  PubMed  Google Scholar 

  19. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.

    Article  CAS  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  22. Yamada S, Nakao A, Fujii T, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas. 2009;38:e13–7.

    Article  PubMed  Google Scholar 

  23. Yoshioka R, Saiura A, Koga R, et al. The implications of positive peritoneal lavage cytology in potentially resectable pancreatic cancer. World J Surg. 2012;36:2187–91.

    Article  PubMed  Google Scholar 

  24. Yamada S, Fujii T, Kanda M, et al. Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg. 2013;100:1791–6.

    Article  CAS  PubMed  Google Scholar 

  25. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  26. Lopez NE, Prendergast C, Lowy AM. Borderline resectable pancreatic cancer: definitions and management. World J Gastroenterol. 2014;20:10740–51.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254:882–93.

    Article  PubMed  Google Scholar 

  28. Kelly KJ, Winslow E, Kooby D, et al. Vein involvement during pancreaticoduodenectomy: is there a need for redefinition of “borderline resectable disease”? J Gastrointest Surg. 2013;17:1209–17.

    Article  PubMed  Google Scholar 

  29. 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;218:401–11.

    Article  PubMed  Google Scholar 

  30. Ueda M, Endo I, Nakashima M, et al. Prognostic factors after resection of pancreatic cancer. World J Surg. 2009;33:104–10.

    Article  PubMed  Google Scholar 

  31. de Jong MC, Li F, Cameron JL, et al. Reevaluating the impact of tumor size on survival following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol. 2011;103:656–62.

    Article  PubMed  Google Scholar 

  32. Petermann D, Demartines N, Schafer M. Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head? HPB Oxford. 2013;15:872–81.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Park H, An S, Eo SH, et al. Survival effect of tumor size and extrapancreatic extension in surgically resected pancreatic cancer: proposal for improved T classification. Hum Pathol. 2014;45:2341–6.

    Article  PubMed  Google Scholar 

  34. Kunzmann V, Ramanathan RK, Goldstein D, et al. Tumor reduction in primary and metastatic pancreatic cancer lesions with nab-paclitaxel and gemcitabine: an exploratory analysis from a phase 3 study. Pancreas. 2017;46:203–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Katsuhisa Ohgi MD, Yusuke Yamamoto MD, Teiichi Sugiura MD, Yukiyasu Okamura MD, Takaaki Ito MD, Ryo Ashida MD & Katsuhiko Uesaka MD

  2. Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki MD

Authors
  1. Katsuhisa Ohgi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Yamamoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teiichi Sugiura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukiyasu Okamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takaaki Ito MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryo Ashida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeshi Aramaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katsuhiko Uesaka MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Yamamoto MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohgi, K., Yamamoto, Y., Sugiura, T. et al. Is Pancreatic Head Cancer with Portal Venous Involvement Really Borderline Resectable? Appraisal of an Upfront Surgery Series. Ann Surg Oncol 24, 2752–2761 (2017). https://doi.org/10.1245/s10434-017-5972-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-5972-6

Keywords

Search

Navigation