Richard Bell1, Braden Te Ao2, Natasha Ironside3, Adam Bartlett4, John A Windsor4, Sanjay Pandanaboyana5. 1. Department of HPB and Transplant Surgery, St James Hospital, Leeds, UK. 2. Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand. 3. HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand. 4. HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 5. HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: spandanaboyana@adhb.govt.nz.
Abstract
INTRODUCTION: The benefit of portal-superior mesenteric vein resection (PSMVR) with pancreatoduodenectomy (PD) remains controversial. This study assesses the impact of PSMVR on resection margin status and survival. METHOD: An electronic search was performed to identify relevant articles. Pooled odds ratios were calculated for outcomes using the fixed or random-effects models for meta-analysis. A decision analytical model was developed for estimating cost effectiveness. RESULTS: Sixteen studies with 4145 patients who underwent pancreatoduodenectomy were included: 1207 patients had PSMVR and 2938 patients had no PSMVR. The R1 resection rate and post-operative mortality was significantly higher in PSMVR group (OR1.59[1.35, 1.86] p=<0.0001, and OR1.72 [1.02,2.92] p = 0.04 respectively). The overall survival at 5-years was worse in the PSMVR group (HR0.20 [0.07,0.55] P = 0.020). Tumour size (p = 0.030) and perineural invasion (P = 0.009) were higher in the PSMVR group. Not performing PSMVR yielded cost savings of $1617 per additional month alive without reduction in overall outcome. CONCLUSION: On the basis of retrospective data this study shows that PD with PSMVR is associated with a higher R1 rate, lower 5-year survival and is not cost-effective. It appears that PD with PSMVR can only be justified if R0 resection can be achieved. The continuing challenge is accurate selection of these patients.
INTRODUCTION: The benefit of portal-superior mesenteric vein resection (PSMVR) with pancreatoduodenectomy (PD) remains controversial. This study assesses the impact of PSMVR on resection margin status and survival. METHOD: An electronic search was performed to identify relevant articles. Pooled odds ratios were calculated for outcomes using the fixed or random-effects models for meta-analysis. A decision analytical model was developed for estimating cost effectiveness. RESULTS: Sixteen studies with 4145 patients who underwent pancreatoduodenectomy were included: 1207 patients had PSMVR and 2938 patients had no PSMVR. The R1 resection rate and post-operative mortality was significantly higher in PSMVR group (OR1.59[1.35, 1.86] p=<0.0001, and OR1.72 [1.02,2.92] p = 0.04 respectively). The overall survival at 5-years was worse in the PSMVR group (HR0.20 [0.07,0.55] P = 0.020). Tumour size (p = 0.030) and perineural invasion (P = 0.009) were higher in the PSMVR group. Not performing PSMVR yielded cost savings of $1617 per additional month alive without reduction in overall outcome. CONCLUSION: On the basis of retrospective data this study shows that PD with PSMVR is associated with a higher R1 rate, lower 5-year survival and is not cost-effective. It appears that PD with PSMVR can only be justified if R0 resection can be achieved. The continuing challenge is accurate selection of these patients.
Authors: Claudio F Feo; Giulia Deiana; Chiara Ninniri; Giuseppe Cherchi; Paola Crivelli; Alessandro Fancellu; Giorgio C Ginesu; Alberto Porcu Journal: World J Surg Oncol Date: 2021-04-18 Impact factor: 2.754
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