Long-term Results of Pancreaticoduodenectomy with Superior Mesenteric and Portal Vein Resection for Ductal Adenocarcinoma in the Head of the Pancreas

Abstract

IntroductionThe benefit of pancreaticoduodenectomy (PD) with superior mesenteric-portal vein resection (PVR) for pancreatic adenocarcinoma (PA) is still controversial in terms of morbidity, mortality and survival. We conducted a retrospective study to analyse outcomes of PD with PVR in a Spanish tertiary centre. MethodsBetween 2002 and 2012, 10 patients underwent PVR (PVR+ group) and 68 standard PD (PVR− group). Morbidity, mortality, overall survival (OS) and disease-free survival (DFS) were compared between PVR+ and PVR− group. Prognostic factors were identified by a Cox regression model. ResultsPostoperative mortality was 5% (4/78), all patients in PVR− group. Morbidity was higher in the PVR− group compared to PVR+ (63% vs 30%, P=.004). OS at 3 and 5 years was 43% and 43% in PVR+ group, 35% and 29% in PVR− group (P=.07). DFS at 3 and 5 years DFS were 28% and 15% in PVR+ group, 25% and 20% in PVR− group (P=.84). Median survival was 23.1 months in PVR− group, and 22.8 months in PVR+ group (P=.73). Factors related with OS were absence of adjuvant treatment (OR 2.9, 95%IC: 1.39–6.14, P=.003), R1 resection (OR 2.3, 95%IC: 1.2–4.43, P=.006), preoperative CA 19.9 level ≥ 170UI/mL (OR 2.3, 95%IC: 1.22–4.32, P=.01). DFS risk factors were R1 resection (OR 2.6, 95%IC: 1.41–4.95, P=.002); moderate or poor tumour differentiation grade (OR 2.7, 95%IC: 1.23–6.17, P=.01); N1 lymph node status (OR 1.8, 95%IC: 1.02–3.19, P=.04); CA 19.9 level ≥ 170UI/mL (OR 2.4, 95%IC: 1.30–4.54, P=.005). ConclusionsPVR for PA can be performed safely. Patients with PVR have a comparable survival to patients undergoing standard PD if disease-free margins can be obtained.