Yuichi Nagakawa1, Jin-Young Jang, Manabu Kawai, Song Cheol Kim, Yosuke Inoue, Yasuhiro Yabushita, Jin Seok Heo, Masayuki Honda, Teiichi Sugiura, Shingo Kagawa, Aoi Hayasaki, Wooil Kwon, Kenichiro Uemura, Ho-Seong Han, Motokazu Sugimoto, Yasuhisa Ando, Masafumi Nakamura, Keita Wada, Yusuke Kumamoto, Hiroaki Osakae, Akihiko Tsuchida, Yoo-Seok Yoon, Joon Seong Park, Hiroki Yamaue, Itaru Endo. 1. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Second Department of Surgery, Wakayama Medical University, Wakayama, Japan Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Hepatobiliary-pancreatic surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVE: To investigate the safety and survival benefits of portal vein and/or superior mesenteric vein (PV/SMV) resection with jejunal vein resection (JVR) for pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA: Few studies have shown the surgical outcome and survival of pancreatic resection with JVR, and treatment strategies for patients with PDAC suspected of jejunal vein (JV) infiltration remain unclear. METHODS: In total, 1260 patients who underwent pancreatectomy with PV/SMV resection between 2013 and 2016 at 50 facilities were included; treatment outcomes were compared between the PV/SMV group (PV/SMV resection without JVR; n = 824), PV/SMV-J1 V group (PV/SMV resection with first jejunal vein resection; n = 394), and PV/SMV-J2,3 V group (PV/SMV resection with second jejunal vein or later branch resection; n = 42). RESULTS: Postoperative complications and mortality did not differ between the three groups. The postoperative complication rate associated with PV/SMV reconstruction was 11.9% in PV/SMV group, 8.6% in PV/SMV-J1 V group, and 7.1% in PV/SMV-J2,3 V group; there were no significant differences among the three groups. Overall survival did not differ between PV/SMV and PV/SMV-J1 V groups (median survival; 29.2 months vs. 30.9 months. p = 0.60). Although PV/SMV-J2,3 V group had significantly shorter survival than PV/SMV group who underwent upfront surgery (p = 0.05), no significant differences in overall survival of patients who received preoperative therapy. Multivariate survival analysis revealed that adjuvant therapy and R0 resection were independent prognostic factors in all groups. CONCLUSIONS: PV/SMV resection with JVR can be safely performed and may provide satisfactory overall survival with the pre-and postoperative adjuvant therapy.
OBJECTIVE: To investigate the safety and survival benefits of portal vein and/or superior mesenteric vein (PV/SMV) resection with jejunal vein resection (JVR) for pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA: Few studies have shown the surgical outcome and survival of pancreatic resection with JVR, and treatment strategies for patients with PDAC suspected of jejunal vein (JV) infiltration remain unclear. METHODS: In total, 1260 patients who underwent pancreatectomy with PV/SMV resection between 2013 and 2016 at 50 facilities were included; treatment outcomes were compared between the PV/SMV group (PV/SMV resection without JVR; n = 824), PV/SMV-J1 V group (PV/SMV resection with first jejunal vein resection; n = 394), and PV/SMV-J2,3 V group (PV/SMV resection with second jejunal vein or later branch resection; n = 42). RESULTS: Postoperative complications and mortality did not differ between the three groups. The postoperative complication rate associated with PV/SMV reconstruction was 11.9% in PV/SMV group, 8.6% in PV/SMV-J1 V group, and 7.1% in PV/SMV-J2,3 V group; there were no significant differences among the three groups. Overall survival did not differ between PV/SMV and PV/SMV-J1 V groups (median survival; 29.2 months vs. 30.9 months. p = 0.60). Although PV/SMV-J2,3 V group had significantly shorter survival than PV/SMV group who underwent upfront surgery (p = 0.05), no significant differences in overall survival of patients who received preoperative therapy. Multivariate survival analysis revealed that adjuvant therapy and R0 resection were independent prognostic factors in all groups. CONCLUSIONS: PV/SMV resection with JVR can be safely performed and may provide satisfactory overall survival with the pre-and postoperative adjuvant therapy.