Giuseppe K Fusai1, Domenico Tamburrino2, Stefano Partelli3, Panagis Lykoudis1, Peter Pipan1, Francesca Di Salvo3, Nassiba Beghdadi4, Safi Dokmak4, Dominik Wiese5, Luca Landoni6, Chiara Nessi6, O R C Busch7, Niccolò Napoli8, Jin-Young Jang9, Wooil Kwon9, Marco Del Chiaro10, Chiara Scandavini11, Mahmoud Abu-Awwad12, Thomas Armstrong12, Mohamed Abu Hilal13, Peter J Allen14, Ammar Javed15, Magnus Kjellman16, Alain Sauvanet4, Detlef K Bartsch5, Claudio Bassi6, E J M Nieveen van Dijkum7, M G Besselink7, Ugo Boggi8, Sun-Whe Kim9, Jin He15, Christofer L Wolfgang15, Massimo Falconi3. 1. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom. 2. Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy. Electronic address: tamburrino.domenico@hsr.it. 3. Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy. 4. Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif, Université de Paris-Paris Diderot, Beaujon Hospital, Clichy, France. 5. Department of Visceral, Thoracic, and Vascular Surgery, Philipps University, Marburg, Germany. 6. Unit of General and Pancreatic Surgery, University and Hospital Trust of Verona, Italy. 7. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Netherlands. 8. Division of General and Transplant Surgery, University of Pisa, Italy. 9. Department of Surgery, Seoul National University College of Medicine, South Korea. 10. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO. 11. Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden. 12. Department of Surgery, University Hospital Southampton, United Kingdom. 13. Department of Surgery, University Hospital Southampton, United Kingdom; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy. 14. Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgical Oncology, Duke University, Durham, NC. 15. Division of Surgical Oncology, Surgical Oncology, Pathology and Oncology, Johns Hopkins Medical Institution, Baltimore, MD. 16. Department of Molecular Medicine and Surgery, Division of Endocrine Surgery, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasms patients is lacking. METHODS: This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. RESULTS: Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). CONCLUSION: This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.
BACKGROUND: The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasmspatients is lacking. METHODS: This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. RESULTS: Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). CONCLUSION: This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.