Giuseppe Nigri1, Niccolò Petrucciani2, Antonio Daniele Pinna3, Matteo Ravaioli3, Elio Jovine4, Francesco Minni5, Gian Luca Grazi6, Piero Chirletti7, Gianpaolo Balzano8, Fabio Ferla9, Luciano De Carlis9, Giuseppe Tisone10, Niccolò Napoli11, Ugo Boggi11, Giovanni Ramacciato2. 1. General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it. 2. General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. 3. General Surgery and Transpantation Unit, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy. 4. General Surgery Unit, Ospedale Maggiore di Bologna, Italy. 5. General Surgery Unit, Policlinico Sant'Orsola Malpighi, Bologna, Italy. 6. Hepato-pancreato-biliary Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 7. General Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. 8. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. 9. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy. 10. Transplantation Unit, University of Tor Vergata, Policlinico Tor Vergata, Roma, Italy. 11. General Surgery and Transplantation Unit, University of Pisa, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Abstract
INTRODUCTION: The aim of this study is to analyze the evolution of pancreatectomy with venous resection in 10 referral Italian centers in the last 25 years. METHODS: A multicenter database of 425 patients submitted to pancreatectomy with venous resection between 1991 and 2015 was retrospectively analyzed. Patients were classified in 5 periods: 1 (1991-1995); 2 (1996-2000); 3 (2001-2005); 4 (2006-2010); 5 (2011-2015). Indications and outcomes were compared according to the period of surgery. RESULTS: Nineteen patients were operated in period 1, 28 in period 2, 91 in period 3, 140 in period 4, and 147 in period 5. Use of neoadjuvant therapy increased from 0% in period 1 and 2-12.1% in period 5. Postoperative complications ranged from 46.3% to 67.8%, and mortality from 5.3% to 9.2%. Median survival progressively increased, from 6 months in period 1-16 months in period 2, 24 months in period 3 and 4 and 35 months in period 5 (p = 0.004). Period, venous and nodal invasion were significant prognostic factors for survival. CONCLUSION: Management and outcomes of pancreatectomy with venous resection have evolved in the last 25 years in Italy. Improvement in patients' multidisciplinary management has lead to significant improvement of median survival.
INTRODUCTION: The aim of this study is to analyze the evolution of pancreatectomy with venous resection in 10 referral Italian centers in the last 25 years. METHODS: A multicenter database of 425 patients submitted to pancreatectomy with venous resection between 1991 and 2015 was retrospectively analyzed. Patients were classified in 5 periods: 1 (1991-1995); 2 (1996-2000); 3 (2001-2005); 4 (2006-2010); 5 (2011-2015). Indications and outcomes were compared according to the period of surgery. RESULTS: Nineteen patients were operated in period 1, 28 in period 2, 91 in period 3, 140 in period 4, and 147 in period 5. Use of neoadjuvant therapy increased from 0% in period 1 and 2-12.1% in period 5. Postoperative complications ranged from 46.3% to 67.8%, and mortality from 5.3% to 9.2%. Median survival progressively increased, from 6 months in period 1-16 months in period 2, 24 months in period 3 and 4 and 35 months in period 5 (p = 0.004). Period, venous and nodal invasion were significant prognostic factors for survival. CONCLUSION: Management and outcomes of pancreatectomy with venous resection have evolved in the last 25 years in Italy. Improvement in patients' multidisciplinary management has lead to significant improvement of median survival.