Venous Resection Research Articles

Comparison between long and short-term venous patencies after pancreatoduodenectomy with portal/superior mesenteric vein resection stratified by reconstruction type

Pancreatic surgery was traditionally contraindicated for tumours adherent to the portal vein (PV) and/or superior mesenteric vein (SMV). Recently, venous resection and/or reconstruction has been demonstrated to be feasible and safe for tumours with invasion into PV and/or SMV. This study aims to compare the patency between various venous reconstructions (VR). This is retrospective study of 76 consecutive patients who underwent pancreaticoduodenectomy or total pancreatectomy with isolated VR from 2006 to 2018. Demographics, tumour histopathology, morbidity, mortality and patency were studied. Kaplan-Meier estimates were performed for primary venous patency. Sixty-two patients underwent pancreaticoduodenectomy and 14 underwent total pancreatectomy. Forty-seven, 19 and 10 patients underwent primary repair (PR), end-to-end anastomosis and interposition graft (IG) respectively. Overall morbidity, major morbidity (Clavien-Dindo >grade 2) and 30-day mortality were 41/76(53.9%), 14/76(18.4%) and 1/76(1.3%), respectively. Twelve patients (15.8%) had venous occlusion including 4(5.3%) acute occlusions within 30 days. Overall 6-month, 1-year and 2-year primary patency was 89.1%, 92.5% and 92.3% respectively. 1-year primary patency of PR was superior to end-to-end anastomosis and IG (PR 100%, end-to-end anastomosis 81.8%, IG 66.7%, p=0.045). Pairwise comparison also demonstrated superior 1-year patency of PR (adjusted p=0.037). Kaplan-Meier estimates demonstrated 80% cumulative overall 2-year venous patency. There was no significant difference between the cumulative venous patency for each VR method (Figure 1): 84 ± 6% for PR, 75 ± 11% for end-to-end anastomosis, 76 ± 15% for IG (p=0.561). Comparison between venous patency by reconstruction type demonstrated superior 1-year primary patency of PR compared to end-to-end anastomosis and IG.

Results of Five Years of a Specialized Unit in Pancreatic Surgery

Purpose: Pancreatic surgery is technically demanding, and requires multidisciplinary management to achieve good results. These are clearly influenced by the volume of cases performed. A specific unit of pancreatic surgery was created in our 900-bed center in 2016 in order to centralize the cases and improve the results. Methods: We present the Results of the first five years of our unit. Results: 172 surgeries (3 case/month) including 72 Whipple procedures (WP), 63 left pancreatectomies (LP). Among them 68 adenocarcinomas, 26 neuroendocrine tumors and 25 cystic neoplasms. Median age: 66 years. Mortality: 4.1%. Significant morbidity (Clavien-Dindo ≥III): 22.1%. Median hospital stay: 12 days (17 days after WP, 8 days after LP). Of the WP, 75% were adenocarcinomas. Pancreatic fistula: 44.4%, B/C grade: 11.1%. Significant morbidity: 27,8%. Of the LP, 13 were adenocarcinomas, 22 neuroendocrine tumors, 3 metastasis, 15 cystic neoplasms. B/C grade fistula: 3.2%. Significant morbidity: 14.3%. 15 cases were performed laparoscopically with good results (median stay 7 days, significant morbidity 0%, fistula 10 of 15, all grade A). Of the 68 resectable adenocarcinomas, 77.9% required WP and 19.1% needed LP. Neoadjuvant treatment: 13.23%. Venous resection: 11.8%. Mortality: 7.4%, significant morbidity 27.9%. R0 resection: 51.5%, R1 was due to unavoidable involvement of anterior and posterior margins in 33 cases. 1-year survival: 82.7%. 1-year disease-free survival: 50%. Conclusion: Pancreatic surgery is demanding and is generally taxed with high morbidity, which may justify the creation of specific surgical teams. We believe that our results are acceptable although there is still room for improvement.

Single center experience of thirty five consecutive total duodenopancreatectomies

Introduction: laparoscopic total duodenopancreatectomy (TLDPE) remains one of the colmplex procedures in minimally invasive abdominal surgery. Objective is to assess the short-term and long-term outcomes of TLDPE. Methods: 35 patients underwent TLDPE during last 10 years. 22 were females, 13 were males.30 patients were operated on because of malignancies and 5 because of benign diseases. Postoperative complications were assessed in order to evaluate the safety and feasibility of laparoscopic approach. Results: To date this is one of the largest single-center experiences of TLDPE. Mean operative time was 466 min and mean blood loss was 356 ml. The postoperative course of 22,8% of patients was complicated by Clavien-Dindo IIIa-V complication. Among them CD V - 5,7%. Mean ICU stay was 3,42 days, while mean hospital stay was 14 days. Rate of complications demanding repeat surgeries was 14,3%. Concomitant venous resection was performed in 10 cases. Venous resection was associated with higher blood loss and operation time. R0 resection was obtained in 97% of cases with mean number of lymph nodes harvested of 13. Median overall survival of patients with pancreatic cancer was 26 months with 5-years OSR of 29%. Mean maximum glucose level during the day was 9,8 mmol/l, HbAc 7,1 with mean demand in long-actin insulin 13,8 U. Median weight loss was 5 kg. One third of patients were complaining on diarrhea. Conclusion: TLDPE is feasible and effective procedure providing satisfactory short-terms and long-term outcomes.

Robotic artery-first approach during pancreatoduodenectomy

Presenter: Fabio Makdissi MD | Nove de Julho Hospital Background: Surgical resection along with adjuvant or neoadjuvant chemotherapy is the only curative modality for the treatment of patients with pancreatic and periampullary tumors. With the increasing use of minimally invasive techniques, laparoscopic and robotic pancreatoduodenectomy (PD) has become more common, but laparoscopic artery-first techniques have only been described by a few studies. The aim of this study is to describe our robotic artery-first technique. Methods: Video clips were compiled from several robotic PD to demonstrate the artery-first technique. This technique consists of early retroperitoneal dissection of the superior mesenteric artery from pancreatic head. Results: There were 73 patients who underwent robotic PD at our center between March 2018 and August 2020. Of these, 24 patients underwent the robotic artery-first approach. The indication for its use was proximity of the tumor to the portal vein or SMV in six cases. In three cases, partial resection of the porto-mesenteric axis was necessary, and the artery-first approach allowed for safe venous resection and reconstruction. In three other cases, the tumor was in close contact with the vein, but it could be resected with free margins without venous resection. In the last 18 patients, the approach was systematically used regardless of the tumor’s proximity to the porto-mesenteric axis. Conclusion: This robotic artery-first approach is feasible and safe for PD. The approach could facilitate robotic PD, and its systematical use could provide some important advantages during the resection phase. The videos could also help HPB surgeons to perform this complex yet important maneuver.

The Length of Portal Vein Abutment on CT is Associated with the Need for Venous Resection during Pancreaticoduodenectomy for Resectable Tumours

The Length of Portal Vein Abutment on CT is Associated with the Need for Venous Resection during Pancreaticoduodenectomy for Resectable Tumours

Prognostic impact of simultaneous venous resections during surgery for resectable pancreatic cancer

Background: The aim of this study was to evaluate the prognostic impact of simultaneous venous resection during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) that was preoperatively staged resectable according to NCCN guidelines. Methods: A retrospective analysis of 153 patients who underwent PD for PDAC was performed. Patients were divided into standard PD and PD with simultaneous vein resection (PDVR). Groups were compared to each other in terms of postoperative morbidity and mortality, disease free (DFS) and overall survival (OS). Results: 114 patients received PD while 39 patients received PDVR. No differences in terms of postoperative morbidity and mortality between both groups were detected. Patients in the VR group presented with a significantly shorter OS in the median (13 vs. 21 months, P=0.011). In subgroup analysis, resection status did not influence OS in the PDVR group (R0 13 vs. R1 12 months, P=0.471) but in the PD group (R0 23 vs. R1 14 months, P=0.043). PDVR was a risk factor of OS in univariate but not multivariable analysis. Conclusion: PDVR for PDAC preoperatively staged resectable resulted in significantly shorter OS regardless of resection status. Patients who require PDVR should be considered for adjuvant chemotherapy in addition to other oncological indications.

Venous resection for locally advanced pancreatic cancer: time trend and outcome analysis of 80 consecutive resections at a high-volume center

Venous resection for locally advanced pancreatic cancer: time trend and outcome analysis of 80 consecutive resections at a high-volume center

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

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.

Distal pancreatectomy with superior mesenteric vein resection without reconstruction for pancreatic neuroendocrine tumor.

Mesenteric and portal vein involvement is seen frequently in pancreatic neoplastic disease and requires venous resection to obtain clear surgical margins. If sufficient collateral circulation is present, venous resection can be performed without reconstruction and without substantial impact on venous drainage.

Outcomes of pancreatectomy with or without venous resection for pancreatic cancer: a systematic review and meta-analysis

Outcomes of pancreatectomy with or without venous resection for pancreatic cancer: a systematic review and meta-analysis

ARTERIAL RESECTION IN PANCREATIC CANCER SURGERY: A SINGLE-CENTER EXPERIENC

Pancreaticoduodenal resection (PDR) with vascular reconstruction is performed in approximately 20 % of pancreatic cancer patients. The superior mesenteric vein resection and reconstruction has become a standard routine surgery, whereas arterial resection during pancreatic surgery is still an issue of controversial debate.The purpose of the study was to evaluate short-and long-term outcomes of PDR with reconstruction of various arteries.Material and Methods. Outcomes of 89 PDRs and pancreaticoduodenectomies performed in patients with stage II–IV periampullary carcinoma were assessed. The average age of the patients was 63.1 ± 8.2. There were 18 (20.2 %) PDRs with vascular reconstruction, of them 7 (7.8 %) were arterial resections.Results. In patients who underwent artery resection (n=7), complications were observed in 5 (71.4 %) cases. Out of 71 patients who underwent PDR without arterial and/or venous resection, 29 (40.8 %) had complications (p=0.229). The postoperative mortality rates were 1 (14.3 %) and 3 (4.2 %), respectively (p=0.319). The median disease-free survival was 5.0 months (95 % CI 2.4–7.6 months) in the arterial resection group and 12.3 months (95 % CI 9.2–15.4 months) in the standard surgery group (log-rank test, p=0,011). The median overall survival was 8.0 months (95 % CI 3.7–12.3 months) in the in the arterial resection group and 21.8 months (95 % CI 15.9–27.7 months) in the standard surgery group (log-rank test, p=0.011).Conclusion. The disease-free and overall survival rates were significantly worse in the arterial resection group than in the standard surgery group. This is most likely due to a small sample of patients. Further studies are needed to analyze the immediate and long-term treatment outcomes of PDR with arterial resection for pancreatic cancer.

Venous resections and reconstructions in surgery of pancreatic cancer

Aim. To evaluate results of venous resections in tumor infiltration of venous wall in pancreatic cancer (PC).&#x0D; Materials and Methods. The study included 74 patients with PC and tumor invasion of the wall of the mesenteric-portal system (T3 N0-1 M0). The control group included patients (n=53), receiving palliative chemotherapy. The average age of patients in the group of surgical treatment was 61.89.8 years, in the control group 63.210.1 years (р0.05), the average diameter of the tumor was 39 mm and 43 mm, respectively (р0.05). In 62 cases of the group of surgical treatment the tumor was located in the head of pancreas (P), the patients were conducted pancreaticoduodenal resection with venous resection. In the rest of cases (n=12) the tumor was located in the body of P, corporocaudal resection of P was conducted with venous resection.&#x0D; Results. In the early postoperative period 2.7% of patients developed thrombosis of the reconstruction zone, 1.4% developed bleeding. 30-Day postoperative lethality was 4.1%. Median survival in surgical treatment of PC with venous resection was higher in comparison with palliative chemotherapy: 19 months vs 13 months, р0.05. In the group of venous resection the lowest annual survival (46.2%) was noted in patients with marginal resection of the vein. No significant differences were found in the parameters of survival with use of direct venous anastomose and venous prosthetics (66.7% vs 63.2%, p0.05).&#x0D; Conclusions. Angioplastic interventions permitting to achieve microscopically complete resection of the tumor in PC with tumor infiltration of mesenteric-portal system, permit to improve survival of patients in comparison with palliative chemotherapy.

Minimally invasive pancreaticoduodenectomy with venous resection: results of a systematic review

Aim : Growing experience with minimally invasive pancreaticoduodenectomy (PD) has led surgeons to expand the indications for this approach. We systematically reviewed the literature on minimally invasive PD with venous resection. Methods : The EMBASE, MEDLINE, and Cochrane central databases were systematically searched for articles from January 2010 to January 2020 describing cases of PD with venous resection. The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcomes were feasibility and conversion rate. Secondary outcomes were morbidity, mortality, blood loss and 1-year survival. Results : The literature search found 9 studies reporting 140 patients undergoing PD with venous resection. Sixty-six PDs were performed robotically (47.1%). The conversion rate ranged from 0% to 55%, blood loss ranged from 200 to 842 mL, and operative time ranged from 397 to 518 min. There were 82 lateral (58.5%) and 18 segmental (12.8%) PDs with venous resection. One patient had an associated arterial resection (0.7%). A graft was used for venous reconstruction in 28 patients (20%). Eight deaths (5.7%) were reported postoperatively. Conclusion : Minimally invasive pancreatectomies with synchronous lateral venous resections are increasingly reported by highly experienced surgeons in high-volume institutions. Further experience is needed to validate this approach and prove its advantages over open surgery.

Long-term outcomes following en bloc resection for pancreatic ductal adenocarcinoma of the head with portomesenteric venous invasion

BackgroundThe aim of this study is to clarify the prognostic influence of venous resection of the portal vein (PV) or superior mesenteric vein (SMV) on long-term outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) of the head with suspected vascular invasion. MethodsFrom May 1995 to December 2014, a total of 557 patients underwent surgery with curative intent for pancreatic cancer of the head. ResultsAmong 557 patients, 106 (19%) underwent pancreaticoduodenectomy (PD) with PV-SMV resection and 89 (75.5%) of these patients were confirmed to have true pathological invasion. The 5-year overall survival rate in patients underwent PV-SMV resection was significantly lower compared with those who did not (18.7% versus 24.3%; p = 0.002). Patients with negative resection margins who underwent PV-SMV resection had a better prognosis than those with positive resection margins who did not undergo PV-SMV resection with positive resection margins (17% versus 6.3% in 5-year overall survival rate; p = 0.003). The overall morbidity rate was not significantly different between PV-SMV resection group and no PV-SMV resection group (p = 0.064). On multivariate analysis, margin status, advanced T stage (3 or 4), lymph node metastasis, and adjuvant therapy were independent prognostic factors for survival. ConclusionPV-SMV resection was related to lower overall survival. However, on multivariate analysis, margin status was a more important prognostic factor than PV-SMV resection and true pathological invasion for survival. Therefore, en bloc PV-SMV resection should be performed when PV-SMV invasion is suspected to achieve R0 resection.

Defining Benchmark Outcomes for Pancreatoduodenectomy With Portomesenteric Venous Resection.

The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.

1556P Extended pancreatectomy in patients with pancreatic cancer

Extended pancreatectomy (EP) is the only potential cure for patients with borderline resectable and locally advanced pancreatic cancer. In the period 2011-2018, 618 resections were performed in patients with pancreatic adenocarcinoma. Standard resections were performed in 476 (77%) patients. EP was performed in 142 (23%) patients. Extended pancreaticoduodenectomy was performed in 79 (55.6%), extended distal resections in 52 (36.6%), extended total pancreatectomy in 11 (7.8%). EP with arterial resections was performed in 14 (2.3%) patients, with venous resections in 91 (14.7%) patients. One or more postoperative complications occurred in 182 patients (38.2%) in the standard resection group and in 63 (44.3%) in the EP group. Mortality was 13.2% (15 patients): 6 (4.2%) patients died after EP and 9 (1.9%) after standard pancreatectomy. Median survival and 5-year overall survival rates were reduced in patients having EP compared with those undergoing a standard resection (15 months, 18% and 25 months, 33%, respectively; c2= 2.83, P= 0.09, c2 = 0.16, P=0.69). These results suggest that morbidity and mortality after EP are comparable with standard pancreatectomy. However, long term results of EP are worse compared with standard pancreatectomy. Extended resections are possible and can increase the number of radically operated patients.

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence.

BACKGROUNDDespite advancements in operative technique and improvements in postoperative managements, postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreatoduodenectomy (PD). There are some reports to predict POPF preoperatively or intraoperatively, but the accuracy of those is questionable. Artificial intelligence (AI) technology is being actively used in the medical field, but few studies have reported applying it to outcomes after PD.AIMTo develop a risk prediction platform for POPF using an AI model.METHODSMedical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016. A total of 38 variables were inserted into AI-driven algorithms. The algorithms tested to make the risk prediction platform were random forest (RF) and a neural network (NN) with or without recursive feature elimination (RFE). The median imputation method was used for missing values. The area under the curve (AUC) was calculated to examine the discriminative power of algorithm for POPF prediction.RESULTSThe number of POPFs was 221 (12.5%) according to the International Study Group of Pancreatic Fistula definition 2016. After median imputation, AUCs using 38 variables were 0.68 ± 0.02 with RF and 0.71 ± 0.02 with NN. The maximal AUC using NN with RFE was 0.74. Sixteen risk factors for POPF were identified by AI algorithm: Pancreatic duct diameter, body mass index, preoperative serum albumin, lipase level, amount of intraoperative fluid infusion, age, platelet count, extrapancreatic location of tumor, combined venous resection, co-existing pancreatitis, neoadjuvant radiotherapy, American Society of Anesthesiologists’ score, sex, soft texture of the pancreas, underlying heart disease, and preoperative endoscopic biliary decompression. We developed a web-based POPF prediction platform, and this application is freely available at http://popfrisk.smchbp.org.CONCLUSIONThis study is the first to predict POPF with multiple risk factors using AI. This platform is reliable (AUC 0.74), so it could be used to select patients who need especially intense therapy and to preoperatively establish an effective treatment strategy.

3D-laparoscopic pancreaticoduodenectomy with superior mesenteric or portal vein resection for pancreatic cancer.

Minimally invasive pancreaticoduodenectomy with synchronous vein resection for pancreatic cancer is controversial. The aim of this study was to evaluate outcomes and describe the surgical technique of 3d-laparoscopic pylorus-resecting pancreaticoduodenectomy (3dLPD) with venous resection for pancreatic cancer. A retrospective cohort analysis was performed with 26 patients [male/female 11/15; median age 68 (range 45-83) years] who underwent 3dLPD with stented pancreaticogastrostomy and superior mesenteric or portal vein resection for pancreatic adenocarcinoma between November 2016 and June 2019. Median follow-up time after surgery was 12months (range 3-32). Median operating time was 340min (range 240-420) and intra-operative blood loss was 100mL (range 0-1000). Type of venous resection and reconstruction was wedge-resection with primary closure (n = 22), wedge-resection with reconstruction using a peritoneal patch (n = 3), and segmental resection with primary end-to-end reconstruction (n = 1). Laparoscopy was converted to open surgery in 4 (15%) patients. Postoperative complications occurred in 10 (38%) patients including severe complications (Clavien-Dindo grade > 2) in 4 (15%). Postoperative mortality was zero. R0 resection was achieved in 21 (81%) patients. Median number of lymph nodes retrieved was 25 (range 10-45). Venous patency was observed in 23 (88%) patients with a median patency duration of 11months (range 0-31). 3dLPD with simultaneous venous resection for pancreatic cancer results in acceptable reconstruction patency and adequacy of surgical oncology without compromising clinical outcomes.

Analysis of textbook outcomes among patients undergoing resection of retroperitoneal sarcoma: A multi-institutional analysis of the US Sarcoma Collaborative.

The novel composite metric textbook outcome (TO) has increasingly been used as a quality indicator but has not been reported among patients undergoing surgical resection for retroperitoneal sarcoma (RPS) using multi-institutional collaborative data. All patients who underwent resection for RPS between 2000 to 2016 from eight academic institutions were included. TO was defined as a patient with R0/R1 resection that discharged to home and was without transfusion, reoperation, grade ≥2 complications, hospital-stay >50th percentile, or 90-day readmission or mortality. Univariate and multivariable analyses were performed. Among 627 patients, 56.1% were female and the median age was 59 years. A minority of patients achieved a TO (34.9%). Factors associated with achieving a TO were tumor size <20 cm and low tumor grade, while ASA class ≥3, history of a prior cardiac event, resection of left colon/rectum, distal pancreatic resection, major venous resection and drain placement were associated with not achieving a TO (all P < .05). Achievement of a TO was associated with improved survival (median:12.7 vs 5.9 years, P < .01). Among patients undergoing resection for RPS, failure to achieve TO is common and associated with significantly worse survival. The use of TO may inform patient expectations and serve as a measure for patient-level hospital performance.

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

Background: The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). Methods: A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. Results: Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67–0.92, p = 0.003), 3-year OS (OR 0.72, 95% CI 0.59–0.87, p = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39–0.83, p = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, p = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06–1.45, p = 0.007), and R1 resection (OR 1.74, 95% CI 1.37–2.20, p < 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28–2.91, p = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81–1.41, p = 0.65). Conclusions: Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC.