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Vascular resection during pancreatectomy for pancreatic head cancer: A technical issue or a prognostic sign?
- Source :
-
Surgery [Surgery] 2021 Feb; Vol. 169 (2), pp. 403-410. Date of Electronic Publication: 2020 Sep 08. - Publication Year :
- 2021
-
Abstract
- Background: There is an increased interest in venous vascular resection associated with pancreatic resection for pancreatic ductal adenocarcinoma as an upfront procedure or after neoadjuvant treatment. The aim of this study was to evaluate the impact of venous vascular resection for pancreatic ductal adenocarcinoma on postoperative and long-term outcomes.<br />Methods: The study is a retrospective analysis of patients who underwent pancreatectomy for pancreatic head pancreatic ductal adenocarcinoma with and without venous vascular resection between January 2010 and April 2018. The impact of venous vascular resection on postoperative and pathologic data was analyzed. Univariate and multivariate analyses of predictors of disease-free and disease-specific survival were analyzed for the entire cohort. A propensity-score matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity.<br />Results: Four hundred and eighty-one patients were included, and 126 (26%) underwent a venous vascular resection. Patients undergoing venous vascular resection had higher morbidity (64% vs 54%; P = .026) with no differences in 90-day postoperative mortality (3.1 vs 2.8%; P = .5). Venous vascular resections were also significantly associated with R1 resections (52% vs 37%; P = .002) and perineural invasion (87% vs 77%; P = .017). Five-year disease-free survival in patients with and without venous vascular resection were 7% and 20% (P = .018), respectively. Independent predictors of worse disease-free survival included venous vascular resection, positive lymph node status, and perineural invasion. Independent predictors of worse disease-specific survival were perineural invasion and positive nodal status, while adjuvant treatment was a protective factor. Five-year disease-specific survival in patients with and without venous vascular resection were 19% and 35% (P = .42).<br />Conclusion: Pancreatectomy with venous vascular resection can be accomplished safely. Venous vascular resections are associated with poor prognostic factors and with a worse clinical outcome, being a significant predictor of cancer recurrence.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal mortality
Carcinoma, Pancreatic Ductal pathology
Chemoradiotherapy, Adjuvant statistics & numerical data
Chemotherapy, Adjuvant statistics & numerical data
Disease-Free Survival
Female
Follow-Up Studies
Humans
Lymph Nodes pathology
Lymphatic Metastasis therapy
Male
Middle Aged
Neoadjuvant Therapy methods
Neoadjuvant Therapy statistics & numerical data
Neoplasm Invasiveness pathology
Neoplasm Recurrence, Local prevention & control
Pancreas blood supply
Pancreas pathology
Pancreas surgery
Pancreatectomy adverse effects
Pancreatectomy statistics & numerical data
Pancreatic Neoplasms mortality
Pancreatic Neoplasms pathology
Prognosis
Retrospective Studies
Risk Assessment statistics & numerical data
Carcinoma, Pancreatic Ductal therapy
Neoplasm Recurrence, Local epidemiology
Pancreatectomy methods
Pancreatic Neoplasms therapy
Veins surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 169
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32912782
- Full Text :
- https://doi.org/10.1016/j.surg.2020.08.002