Dominique Gantois1, Théophile Guilbaud1, Ugo Scemama2, Edouard Girard3, Olivier Picaud1, Marine Lefevre4, Myriam Elgani5, Zeinab Hamidou6, Vincent Moutardier1, Paul Balandraud7, Mircea Chirica3, Louise Barbier8, David Fuks9, David Jérémie Birnbaum10. 1. Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France. 2. Department of Radiology, Hôpital Nord, Aix-Marseille University, Marseille, France. 3. Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, Grenoble, France. 4. Department of Anatomopathology, Institut Mutualiste Montsouris, Paris, France. 5. Department of Anatomopathology, Hôpital Trousseau, Tours, France. 6. Self Perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille cedex 20, France. 7. Department of Digestive and Oncologic Surgery, Hôpital D'Instruction des Armées St-Anne, Toulon, France. 8. Department of Digestive, Oncologic, Metabolic Surgery and Liver Transplantation, Hôpital Trousseau, Tours, France. 9. Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France. 10. Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France. david.birnbaum@ap-hm.fr.
Abstract
PURPOSE: Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC. METHODS: From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified. RESULTS: Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22-13.44], p = 0.023). Tumor size ≥ 30 mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26-12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001). CONCLUSION: Tumor size ≥ 30 mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.
PURPOSE: Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC. METHODS: From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified. RESULTS: Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22-13.44], p = 0.023). Tumor size ≥ 30 mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26-12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001). CONCLUSION: Tumor size ≥ 30 mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.
Authors: Jordan M Cloyd; Matthew H G Katz; Laura Prakash; Gauri R Varadhachary; Robert A Wolff; Rachna T Shroff; Milind Javle; David Fogelman; Michael Overman; Christopher H Crane; Eugene J Koay; Prajnan Das; Sunil Krishnan; Bruce D Minsky; Jeffrey H Lee; Manoop S Bhutani; Brian Weston; William Ross; Priya Bhosale; Eric P Tamm; Huamin Wang; Anirban Maitra; Michael P Kim; Thomas A Aloia; Jean-Nicholas Vauthey; Jason B Fleming; James L Abbruzzese; Peter W T Pisters; Douglas B Evans; Jeffrey E Lee Journal: J Gastrointest Surg Date: 2016-10-24 Impact factor: 3.452
Authors: Cristina R Ferrone; Giovanni Marchegiani; Theodore S Hong; David P Ryan; Vikram Deshpande; Erin I McDonnell; Francesco Sabbatino; Daniela Dias Santos; Jill N Allen; Lawrence S Blaszkowsky; Jeffrey W Clark; Jason E Faris; Lipika Goyal; Eunice L Kwak; Janet E Murphy; David T Ting; Jennifer Y Wo; Andrew X Zhu; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2015-01 Impact factor: 12.969