Surgical outcome of porto-mesenteric resection for borderline pancreatic cancer. A single tertiary referral centre experience

Abstract

Background: Although recent series have concluded that major venous resection (VR) for borderline pancreatic cancer (BLPC) with porto-mesenteric involvement may be considered safe with comparable long-term survival compared to standard pancreaticoduodenenctomy (PD), the matter is still debated due to controversial evidences. The present study aims to evaluate in-hospital complication rate and surgical outcome after VR in a tertiary referral center. Methods: A retrospectively collected database running from April 2011 to January 2017 was performed selecting for patients undergoing PD with or without VR for pancreatic cancer. Perioperative data and pathological findings were statistically analyzed. Results: We identified 314 patients, of whom 277 (88.2%) underwent standard PD and 37 (11.8%) received concomitant VR. No statistically significant differences between the two groups were identified comparing mean age, median CA19.9 level, post-operative morbidity and mortality rate (p>0.05). Conversely, RV was associated with significantly higher median blood loss (p<0.001) and positive margin status rate (43.2% vs 21.7%; p<0.001) compared to standard PD. Conclusion: Porto-mesenteric resection for BLPC is feasible and safe when performed by experienced surgeon with overall morbidity and mortality comparable to standard PD. However, our series suggests that patients affected by BLPC should be addressed to neoadjuvant treatment first, as upfront VR seems to lead to a significantly lower rate of radical surgery.