Portal vein resection and reconstruction with artificial blood vessels is safe and feasible for pancreatic ductal adenocarcinoma patients with portal vein involvement: Chinese center experience.

Zhi-Bo Xie,De-Liang Fu,Yi-Fan Zhang,Yong-Jian Jiang,Lie Yao,Ji Li,Cai-Feng Zou,Ji-Chun Gu,Chen Jin,Feng Yang

doi:10.18632/oncotarget.20847

Abstract

Evidence shows that portal vein resection (PVR) increase the resectability but does little benefit to overall survival in all pancreatic ductal adenocarcinoma (PDAC) patients. But for patients with portal vein involvement, PVR is the only radical choice. But whether the PDAC patients with portal vein involvement would benefit from radical pancreaticoduodenectomy with PVR or not is controversial. All 204 PDAC patients with portal vein involvement were enrolled in this study [PVR group, n=106; surgical bypass (SB) group, n=52; chemotherapy group, n=46]. Overall survival and prognostic factors were analyzed among three groups. Moreover, a literature review of 13 studies were also conducted. Among 3 groups, patients in PVR group achieved a significant longer survival (median survival: PVR group, 22.83 months; SB group, 7.26 months; chemotherapy group, 10.64 months). Therapy choice [hazard ratio (HR) =1.593, 95% confidence interval (CI) 1.323 to 1.918, P<0.001], body mass index (HR=0.772, 95% CI 0.559 to 0.994, P=0.044) and carbohydrateantigen 19-9 (HR=1.325, 95% CI 1.064 to 1.651, P=0.012) were independent prognostic factors which significantly affected overall survival. Pancreaticoduodenectomy combined with PVR and reconstruct with artificial blood vessels is a safe and an appropriate therapy choice for resectable PDAC patients with portal vein involvement.

Highlights

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignant tumors worldwide [1]
Three pancreatic ductal adenocarcinoma (PDAC) patients in portal vein resection (PVR) group were found liver metastasis during intraoperative exploration. They underwent surgical bypass (SB) procedure and were excluded from our study. Another two PDAC patients in PVR group were found that primary tumors were without the ability of reconstruction, and underwent SB procedure were divided into SB group
204 eligible PDCA patients were divided into PVR group (n=106), SB group (n=52) and chemo group (n=46)

Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignant tumors worldwide [1]. The incidence rate of PDAC is increasing in China nowadays [2]. For PDAC patients, pancreatic surgery currently provides the only chance of cure or long-term survival [7]. Most patients are not candidates for surgical resection due to distant metastasis or vascular involvement at the time of diagnosis [8]. Vascular involvement used to be a contradiction for PDAC surgery because patients with vascular involvement have a high risk of systemic metastasis possibility [9]. Many studies claim that PVR increase the resectability of PDAC, but do little benefit to survival [11,12,13]. A newly published meta-analysis find out that pancreatic resection with PVR are associated with increased postoperative mortality, higher rates of non-radical surgery and worse survival [14]

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