H Elberm1, R Ravikumar2, C Sabin3, M Abu Hilal4, A Al-Hilli4, S Aroori5, G Bond-Smith6, S Bramhall7, C Coldham7, J Hammond8, R Hutchins6, C Imber2, G Preziosi2, A Saleh9, M Silva10, J Simpson8, G Spoletini10, D Stell5, J Terrace11, S White9, S Wigmore11, G Fusai2. 1. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK. Electronic address: Hassan.elberm@nhs.net. 2. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK. 3. Research Department of Infection and Population Health, UCL, Royal Free Campus, UK. 4. Department of HPB Surgery, Southampton General Hospital, Southampton, UK. 5. Department of HPB Surgery, Plymouth Hospitals, Plymouth, UK. 6. Department of HPB Surgery, Royal London Hospital, London, UK. 7. Liver Unit, University Hospital Birmingham, Birmingham, UK. 8. Department of HPB, Nottingham University Hospitals, UK. 9. Department of HPB and Transplantation, Freeman Hospital, Newcastle, UK. 10. Department of HPB Surgery, Churchill Hospital, Oxford, UK. 11. Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK.
Abstract
BACKGROUND: Most resectable pancreatic cancers are classified as T3, including those involving the porto-mesenteric vein. Survival and perioperative morbidity for venous resection have been found to be comparable to standard resection. We investigate factors associated with short and long term outcomes in pancreaticoduodenectomy with (PDVR) and without (PD) venous resection exclusively for T3 adenocarcinoma of the head of the pancreas. METHODS: This is a UK multicenter retrospective cohort study assessing outcomes in patients undergoing PD and PDVR. All consecutive patients with T3 only adenocarcinoma of the head of the pancreas undergoing surgery between December 1998 and June 2011 were included. Multivariable logistic and proportional hazards regression analyses were performed to determine the association between the surgical groups and in-hospital mortality (IHM) and overall survival (OS). RESULTS: 1070 patients were included of whom 840 (78.5%) had PD and 230 (21.5%) had PDVR. Factors independently associated with IHM were a high creatinine (aHR 1.14, p = 0.02), post-operative bleeding (aHR 2.86, p = 0.04) and a re-laparotomy (aHR 8.42, p = 0.0001). For OS, multivariable analyses identified R1 resection margin status (aHR 1.22, p = 0.01), N1 nodal status (aHR 1.92, p = 0.0001), perineural invasion (aHR 1.37, p = 0.002), tumour size >20mm (aHR 0.63, p = 0.0001) and a relaparotomy (aHR 1.84, p = 0.0001) to be independently associated with overall mortality. CONCLUSION: This study on T3 adenocarcinoma of the head of the pancreas suggests that IHM is strongly associated with perioperative complications whilst OS is affected by histological parameters. Detailed pre-operative disease evaluation and advances in oncological treatment have the potential to improve OS.
BACKGROUND: Most resectable pancreatic cancers are classified as T3, including those involving the porto-mesenteric vein. Survival and perioperative morbidity for venous resection have been found to be comparable to standard resection. We investigate factors associated with short and long term outcomes in pancreaticoduodenectomy with (PDVR) and without (PD) venous resection exclusively for T3 adenocarcinoma of the head of the pancreas. METHODS: This is a UK multicenter retrospective cohort study assessing outcomes in patients undergoing PD and PDVR. All consecutive patients with T3 only adenocarcinoma of the head of the pancreas undergoing surgery between December 1998 and June 2011 were included. Multivariable logistic and proportional hazards regression analyses were performed to determine the association between the surgical groups and in-hospital mortality (IHM) and overall survival (OS). RESULTS: 1070 patients were included of whom 840 (78.5%) had PD and 230 (21.5%) had PDVR. Factors independently associated with IHM were a high creatinine (aHR 1.14, p = 0.02), post-operative bleeding (aHR 2.86, p = 0.04) and a re-laparotomy (aHR 8.42, p = 0.0001). For OS, multivariable analyses identified R1 resection margin status (aHR 1.22, p = 0.01), N1 nodal status (aHR 1.92, p = 0.0001), perineural invasion (aHR 1.37, p = 0.002), tumour size >20mm (aHR 0.63, p = 0.0001) and a relaparotomy (aHR 1.84, p = 0.0001) to be independently associated with overall mortality. CONCLUSION: This study on T3 adenocarcinoma of the head of the pancreas suggests that IHM is strongly associated with perioperative complications whilst OS is affected by histological parameters. Detailed pre-operative disease evaluation and advances in oncological treatment have the potential to improve OS.
Authors: Thijs de Rooij; Sjors Klompmaker; Mohammad Abu Hilal; Michael L Kendrick; Olivier R Busch; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-02-17 Impact factor: 46.802
Authors: Carolijn L Nota; Maurice J Zwart; Yuman Fong; Jeroen Hagendoorn; Melissa E Hogg; Bas Groot Koerkamp; Marc G Besselink; I Quintus Molenaar Journal: J Vis Surg Date: 2017-08-21