Synchronous portal or superior mesenteric vein resection during pancreatectomy for pancreatic ductal adenocarcinoma: a single center study

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis without surgery. Selected patients with portal or superior mesenteric vein (PV/SMV) infiltration undergo venous resection. The present study aimed to compare the perioperative factors and survival outcomes for pancreatic resection with/without PV/SMV resection in patients with PDAC. Methods: A total of 108 patients requiring pancreatectomy combined with PV/SMV resection for PDAC between 1/2009 and 12/2017 were included in this retrospective analysis. 216 of 798 resected PDAC patients without PV/SMV resection during the same period were matched to control group by TNM stage, preoperative CA19-9, tumor differentiation, adjuvant chemotherapy and year of operation. Results: Patients undergoing PV/SMV resection had an increased risk of intraoperative blood loss (400.0 vs. 275.0 ml; P< 0.001), reoperation (1.9% vs. 0%; P=0.045) and 30-day mortality (1.9% vs. 0%; P=0.045) compared with those undergoing standard surgery. A trend toward worse survival in PV/SMV resection was observed from median survival time (13.3 vs 18.3 mo.; P=0.092), although the study was not powered to detect a difference. In PV/SMV resection group, there was a significant difference between tumor axis < 3cm and ≥3cm in terms of median survival time (21.7 vs. 10.8 mo.; P=0.002) while length of PV/SMV resection showed no relation to survival. Conclusion: PV/SMV resection was associated with increased intraoperative risk and postoperative mortality. PDAC patients with PV/SMV resection seemed to have a worse survival compared with those undergoing standard surgery, especially when the tumor axis ³3cm. This may be related to more advanced disease in this group.