Franz Mierke1, Sebastian Hempel1, Marius Distler1, Daniela E Aust2, Hans-Detlev Saeger1, Jürgen Weitz1, Thilo Welsch3. 1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. 2. Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. 3. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. thilo.welsch@uniklinikum-dresden.de.
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.
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.
Authors: S Battini; F Faitot; A Imperiale; A E Cicek; C Heimburger; G Averous; P Bachellier; I J Namer Journal: BMC Med Date: 2017-03-16 Impact factor: 8.775
Authors: Oliver Beetz; Akin Sarisin; Alexander Kaltenborn; Jürgen Klempnauer; Michael Winkler; Gerrit Grannas Journal: World J Surg Oncol Date: 2020-08-20 Impact factor: 2.754
Authors: Georgios A Kaissis; Fabian K Lohöfer; Sebastian Ziegelmayer; Julia Danner; Carsten Jäger; Rebekka Schirren; Donna Ankerst; Güralp O Ceyhan; Helmut Friess; Ernst J Rummeny; Wilko Weichert; Rickmer F Braren Journal: PLoS One Date: 2019-01-02 Impact factor: 3.240