Preoperative Decision to Perform Portal Vein Resection Improves Survival in Patients with Resectable Pancreatic Head Cancer Adjacent to Portal Vein

Abstract

Introduction: We hypothesized that preoperatively planned portal vein resection (PVR), which prevents from approaching tumors, improves survival in patients with resectable pancreatic head cancer adjacent to the portal vein (PhC-PV). The decision to perform PVR is difficult in patients with resectable PhC-PV. Methods: This is a retrospective, bi-institutional study of patients undergoing pancreatoduodenectomy (PD) for resectable PhC-PV from 2009 to 2018. We compared clinical data of patients who underwent PD with preoperatively planned PVR (planned PVR group) and those who underwent conventional PD (cPD) in which decision to perform PVR was made intraoperatively (cPD group). Results: Among the study population of 176 patients, 53 patients (30.1 %) underwent PD with planned PVR. The remaining 123 patients (69.9%) underwent cPD. Tumor characteristics were similar between the two groups. Operation time and major complication rates did not differ between the two groups. The local recurrence rate of patients in the planned PVR group (28.3%) was lower than that of the cPD group (44.7 %, p = 0.041). Median overall survival (OS) was longer in the planned PVR group than in the cPD group (32 months vs. 27 months, p = 0.011). Multivariate analysis revealed that having undergone planned PVR was an independent factor for favorable OS (hazard ratio 1.65; 95% confidence interval 1.08–2.61; p = 0.021). Conclusions: The preoperative decision to perform PVR improves survival by enhancing local control of resectable pancreatic head cancer adjacent to the PV.