BACKGROUND: Some clinicians have argued that combining pancreatic and portomesenteric venous resection could improve the rates of long-term survival. However, whether resection of the portosplenomesenteric vein could provide an acceptable survival benefit to patients with pancreatic cancer involving the portosplenomesenteric system remains controversial. The purpose of this study was to determine the significance of pathological portosplenomesenteric venous invasion on survival in patients who underwent surgical management for pancreatic adenocarcinoma. METHODS: Patients who underwent curative surgical treatment were divided into two subgroups: those with pathological invasion to the portosplenomesenteric vein (PV-positive group) and those without invasion (PV-negative group). RESULTS: Of 160 studied patients, the median overall survival was 48.0 months after pancreatic surgery in the PV-negative group and 18.0 months in the PV-positive group. The incidence of postoperative peritoneal dissemination was significantly lower in the PV-negative group than in the PV-positive group. Accordingly, patients in the PV-negative group showed a cumulative rate of pancreatic cancer recurrence at 2 years after pancreatic surgery of 54.4%, while this rate was 89.4% in the PV-positive group. Finally, an elevated presurgical serum CA19-9 level (>700 IU/mL) was found to be significantly associated with a poor outcome after surgery in pancreatic cancer patients with pathological portosplenomesenteric venous invasion. CONCLUSIONS: Pancreatic cancer carries a high risk of recurrence even if surgical resection is technically possible. The current study suggested that portosplenomesenteric involvement and preoperative high serum CA19-9 are poor prognostic indications; however, the findings provided little insight into the role of neoadjuvant therapy in such patients.
BACKGROUND: Some clinicians have argued that combining pancreatic and portomesenteric venous resection could improve the rates of long-term survival. However, whether resection of the portosplenomesenteric vein could provide an acceptable survival benefit to patients with pancreatic cancer involving the portosplenomesenteric system remains controversial. The purpose of this study was to determine the significance of pathological portosplenomesenteric venous invasion on survival in patients who underwent surgical management for pancreatic adenocarcinoma. METHODS:Patients who underwent curative surgical treatment were divided into two subgroups: those with pathological invasion to the portosplenomesenteric vein (PV-positive group) and those without invasion (PV-negative group). RESULTS: Of 160 studied patients, the median overall survival was 48.0 months after pancreatic surgery in the PV-negative group and 18.0 months in the PV-positive group. The incidence of postoperative peritoneal dissemination was significantly lower in the PV-negative group than in the PV-positive group. Accordingly, patients in the PV-negative group showed a cumulative rate of pancreatic cancer recurrence at 2 years after pancreatic surgery of 54.4%, while this rate was 89.4% in the PV-positive group. Finally, an elevated presurgical serum CA19-9 level (>700 IU/mL) was found to be significantly associated with a poor outcome after surgery in pancreatic cancerpatients with pathological portosplenomesenteric venous invasion. CONCLUSIONS:Pancreatic cancer carries a high risk of recurrence even if surgical resection is technically possible. The current study suggested that portosplenomesenteric involvement and preoperative high serum CA19-9 are poor prognostic indications; however, the findings provided little insight into the role of neoadjuvant therapy in such patients.
Authors: Nathan Mollberg; Nuh N Rahbari; Moritz Koch; Werner Hartwig; Yumiko Hoeger; Markus W Büchler; Jürgen Weitz Journal: Ann Surg Date: 2011-12 Impact factor: 12.969
Authors: Helmut Oettle; Stefan Post; Peter Neuhaus; Klaus Gellert; Jan Langrehr; Karsten Ridwelski; Harald Schramm; Joerg Fahlke; Carl Zuelke; Christof Burkart; Klaus Gutberlet; Erika Kettner; Harald Schmalenberg; Karin Weigang-Koehler; Wolf-Otto Bechstein; Marco Niedergethmann; Ingo Schmidt-Wolf; Lars Roll; Bernd Doerken; Hanno Riess Journal: JAMA Date: 2007-01-17 Impact factor: 56.272
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: Cristina R Ferrone; Giovanni Marchegiani; Theodore S Hong; David P Ryan; Vikram Deshpande; Erin I McDonnell; Francesco Sabbatino; Daniela Dias Santos; Jill N Allen; Lawrence S Blaszkowsky; Jeffrey W Clark; Jason E Faris; Lipika Goyal; Eunice L Kwak; Janet E Murphy; David T Ting; Jennifer Y Wo; Andrew X Zhu; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2015-01 Impact factor: 12.969
Authors: Ioannis T Konstantinidis; Andrew L Warshaw; Jill N Allen; Lawrence S Blaszkowsky; Carlos Fernandez-Del Castillo; Vikram Deshpande; Theodore S Hong; Eunice L Kwak; Gregory Y Lauwers; David P Ryan; Jennifer A Wargo; Keith D Lillemoe; Cristina R Ferrone Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: R Alvarez; M Musteanu; E Garcia-Garcia; P P Lopez-Casas; D Megias; C Guerra; M Muñoz; Y Quijano; A Cubillo; J Rodriguez-Pascual; C Plaza; E de Vicente; S Prados; S Tabernero; M Barbacid; F Lopez-Rios; M Hidalgo Journal: Br J Cancer Date: 2013-08-01 Impact factor: 7.640