Pancreaticoduodenectomy Combined with Vascular Resection and Reconstruction for Patients with Locally Advanced Pancreatic Cancer: A Multicenter, Retrospective Analysis

Yi Gong,Qilong Chen,Geng Chen,Zheng Wu,Qi Wang,Dong Zhang,Ping Bie,Tieying He,Leida Zhang,Haining Fan,Jun Ding,Hongyu Zhang,Huaizhi Wang,Surinder K Batra

doi:10.1371/journal.pone.0070340

Abstract

ObjectiveThe aim of this study was to present the therapeutic outcome of patients with locally advanced pancreatic cancer treated with pancreatoduodenectomy combined with vascular resection and reconstruction in addition to highlighting the mortality/morbidity and main prognostic factors associated with this treatment.Materials and MethodsWe retrospectively analyzed the clinical and pathological data of a total of 566 pancreatic cancer patients who were treated with PD from five teaching hospitals during the period of December 2006–December 2011. This study included 119 (21.0%) patients treated with PD combined with vascular resection and reconstruction. We performed a detailed statistical analysis of various factors, including postoperative complications, operative mortality, survival rate, operative time, pathological type, and lymph node metastasis.ResultsThe median survival time of the 119 cases that received PD combined with vascular resection was 13.3 months, and the 1-, 2-, and 3-year survival rates were 30.3%, 14.1%, and 8.1%, respectively. The postoperative complication incidence was 23.5%, and the mortality rate was 6.7%. For the combined vascular resection group, complications occurred in 28 cases (23.5%). For the group without vascular resection, complications occurred in 37 cases (8.2%). There was significant difference between the two groups (p = 0.001). The degree of tumor differentiation and the occurrence of complications after surgery were independent prognostic factors that determined the patients’ long-term survival.ConclusionsCompared with PD without vascular resection, PD combined with vascular resection and reconstruction increased the incidence of postoperative complications. However, PD combined with vascular resection and reconstruction could achieve the complete removal of tumors without significantly increasing the mortality rate, and the median survival time was higher than that of patients who underwent palliative treatment. In addition, the two independent factors affecting the postoperative survival time were the degree of tumor differentiation and the presence or absence of postoperative complications.

Highlights

Pancreatic cancer is a highly malignant tumor of the digestive system
Compared with PD without vascular resection, PD combined with vascular resection and reconstruction increased the incidence of postoperative complications
PD combined with vascular resection and reconstruction could achieve the complete removal of tumors without significantly increasing the mortality rate, and the median survival time was higher than that of patients who underwent palliative treatment

Summary

Introduction

Pancreatic cancer is a highly malignant tumor of the digestive system. In recent years, the incidence and mortality of pancreatic cancer have shown an upward trend worldwide [1], as the mortality rate of pancreatic cancer has leapt to fifth among cancerrelated deaths [2]. The surgical removal of the entire tumor (en bloc resection of the pancreas and surrounding structures) is still considered the only possible clinical approach to cure pancreatic cancer [3]. Due to tumor invasions adjacent vascular, the surgical resection rate is only 15% to 20% [6]. The surgical approach of pancreatoduodenectomy (PD) combined with PV and SMV resection and reconstruction has been widely applied in clinical practice to remove the tumor completely. Several researchers have compared multiple aspects of PD combined with vascular reconstruction with PD surgery alone, including postoperative complications, mortality, survival, and surgery-related parameters. This study involved pancreatic cancer patients who were treated with PD combined with vascular resection in the pancreas treatment centers of multiple teaching hospitals in China. We investigated the primary factors that determined patient prognosis

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Discussion

Conclusion