INTRODUCTION: The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in PDAC patients. METHODS: Clinicopathologic, perioperative, and survival data of patients undergoing pancreatic head resection (PHR) for PDAC 1994-2014 were reviewed from a prospective database. RESULTS: Three hundred fifty nine patients had PHR for PDAC: 208 (58 %) underwent SPR, 131 (36 %) additional PV, and 20 (6 %) MV. The postoperative complication rate in MV (65 %) was slightly higher than in PV (56 %) or SPR (50 %; p = 0.32). MV patients had higher in-hospital mortality (10 %) than SPR (3.8 %) and PV (1.5 %) patients (p = 0.12). Nodal status was comparable, whereas more patients in PV and MV had final R0 resection (p = 0.02). Five-year survival was 7 % after MV versus 17 % in patients without MV (p = 0.07). Multivariate survival analysis identified resection margin, nodal disease, blood transfusions, and MV are set as independent risk factors for overall survival. CONCLUSION: Multivisceral pancreatic head resections for PDAC are associated with increased perioperative morbidity and mortality, without improving oncologic outcome. Portal vein resection can be performed safely to reach R0 resection and its survival benefits.
INTRODUCTION: The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in PDACpatients. METHODS: Clinicopathologic, perioperative, and survival data of patients undergoing pancreatic head resection (PHR) for PDAC 1994-2014 were reviewed from a prospective database. RESULTS: Three hundred fifty nine patients had PHR for PDAC: 208 (58 %) underwent SPR, 131 (36 %) additional PV, and 20 (6 %) MV. The postoperative complication rate in MV (65 %) was slightly higher than in PV (56 %) or SPR (50 %; p = 0.32). MVpatients had higher in-hospital mortality (10 %) than SPR (3.8 %) and PV (1.5 %) patients (p = 0.12). Nodal status was comparable, whereas more patients in PV and MV had final R0 resection (p = 0.02). Five-year survival was 7 % after MV versus 17 % in patients without MV (p = 0.07). Multivariate survival analysis identified resection margin, nodal disease, blood transfusions, and MV are set as independent risk factors for overall survival. CONCLUSION: Multivisceral pancreatic head resections for PDAC are associated with increased perioperative morbidity and mortality, without improving oncologic outcome. Portal vein resection can be performed safely to reach R0 resection and its survival benefits.
Authors: Irene Esposito; Jörg Kleeff; Frank Bergmann; Caroline Reiser; Esther Herpel; Helmut Friess; Peter Schirmacher; Markus W Büchler Journal: Ann Surg Oncol Date: 2008-03-20 Impact factor: 5.344
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Reena Ravikumar; Caroline Sabin; Mohammad Abu Hilal; Simon Bramhall; Steven White; Stephen Wigmore; Charles J Imber; Giuseppe Fusai Journal: J Am Coll Surg Date: 2013-11-27 Impact factor: 6.113
Authors: Jennifer F Tseng; Chandrajit P Raut; Jeffrey E Lee; Peter W T Pisters; Jean-Nicolas Vauthey; Eddie K Abdalla; Henry F Gomez; Charlotte C Sun; Christopher H Crane; Robert A Wolff; Douglas B Evans Journal: J Gastrointest Surg Date: 2004-12 Impact factor: 3.452
Authors: James T McPhee; Joshua S Hill; Giles F Whalen; Maksim Zayaruzny; Demetrius E Litwin; Mary E Sullivan; Frederick A Anderson; Jennifer F Tseng Journal: Ann Surg Date: 2007-08 Impact factor: 12.969
Authors: Mehrdad Nikfarjam; Mandeep Sehmbey; Eric T Kimchi; Niraj J Gusani; Serene Shereef; Diego M Avella; Kevin F Staveley-O'Carroll Journal: J Gastrointest Surg Date: 2009-02-07 Impact factor: 3.452