Abstract
SummaryIntroductionPortal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma.Patients and methodsSingle, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short- and long-term survival were assessed via multivariate logistic and Cox regression.ResultsBaseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66, 95 % CI 1.24–91.30). Follow-up was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10–3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31–3.58) were independent predictors.ConclusionDespite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.
Highlights
Complete surgical resection of pancreatic ductal adenocarcinoma (PDAC) represents the key factor for survival despite advances in chemo- and radiochemotherapy
MD Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25)
The feasibility of portal vein resection should be evaluated in every potential candidate at risk
Summary
Complete surgical resection of pancreatic ductal adenocarcinoma (PDAC) represents the key factor for survival despite advances in chemo- and radiochemotherapy. In the 1970s, Fortner first described a radical en bloc surgical resection of venous portal branches and surrounding tissues [1]. Despite this approach might improve survival in locally advanced PDAC, surgeons often are concerned about this technique in fear of the potential additional risk for perioperative and postoperative morbidity and mortality [2,3,4,5]. We aimed to review our long-term experience to determine the additional value of portal venous resection in locally advanced PDAC.
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