Highlights
- •Tangential vein resections are not associated with higher rates of local recurrence
- •Long-term outcomes are similar between tangential versus segmental venous resection
- •Tumor features rather than vein resection techniques affect survival outcomes
- •Tangential vein resections are associated with lower postoperative complications
- •Tangential vein resections should be preferred, whenever technically feasible
Abstract
Introduction
Few studies analysed the impact of different venous resection techniques on recurrence
in patients with pancreatic ductal adenocarcinoma (PDAC). Primary aim was to compare
local recurrence rate and disease-free survival (DFS) between patients who underwent
pancreatectomy with tangential versus segmental resection of portal vein/superior
mesenteric vein.
Materials and methods
All consecutive patients who underwent pancreatectomy with venous resection for PDAC
between 2009 and 2019 were included. A propensity score matching (PSM) was used to
reduce the effect of treatment selection bias.
Results
Overall, 120 patients (68%) underwent pancreatectomy with tangential venous resection
and 57 patients (32%) were submitted to pancreatectomy with segmental venous resection.
After a median follow-up of 24 months, local recurrence was comparable between the
two groups (tangential: n = 32/120, 26.7% versus segmental: n = 10/57, 17.5%; p = 0.58). The median DFS was 17 months (IQR 9–31) in patients who underwent tangential
resection, as compared to 12 months (IQR 5–21) in those who underwent segmental resection
(p = 0.049). After PSM (n = 106), the median DFS was 18 months (IQR 9–26) in the tangential resection group,
and 12 months (IQR 5–21) in the segmental resection group (p = 0.17). In the PSM population, lymph node ratio (HR 4.83; p = 0.028) and tumor size >25 mm (HR 3.26; p = 0.007) were identified as determinants of local recurrence.
Conclusion
Tangential venous resections are not associated with a higher rate of local recurrence.
Long-term outcomes are more related to tumors characteristics than to venous resection
techniques. A step-up approach to vein resection, with tangential resection being
performed whenever technically feasible, should be strongly encouraged.
Keywords
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References
- Cancer statistics, 2020.CA A Cancer J Clin. 2020; 70: 7-30https://doi.org/10.3322/caac.21590
- International study group of pancreatic surgery. Borderline resectable pancreatic cancer: a consensus statement by the international study group of pancreatic surgery (ISGPS).Surgery. 2014; 155: 977-988https://doi.org/10.1016/j.surg.2014.02.001
- Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: an intention to treat analysis of the National Cancer Database.Surgery. 2016; 160: 1080-1096https://doi.org/10.1016/j.surg.2016.06.010
- Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages.PLoS Med. 2010; 7e1000267https://doi.org/10.1371/journal.pmed.1000267
- Pancreatic cancer.Lancet. 2011; 378: 607-620https://doi.org/10.1016/S0140-6736(10)62307-0
- Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis.Br J Surg. 2021; 109: 96-104https://doi.org/10.1093/bjs/znab345
- Postoperative outcomes of tangential versus segmental resection and end-to-end reconstruction of the superior mesenterico-portal vein during pancreatoduodenectomy for pancreatic adenocarcinoma: a single-center experience.Anticancer Res. 2021; 41: 5123-5130https://doi.org/10.21873/anticanres.15329
- The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy.HPB. 2018; 20: 140-146https://doi.org/10.1016/j.hpb.2017.08.012
- Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery.HPB. 2016; 18: 615-622https://doi.org/10.1016/j.hpb.2016.05.010
- Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer.Br J Surg. 2017; 104: 1539-1548https://doi.org/10.1002/bjs.10580
- Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection.J Vasc Surg. 2015; 62: 424-433https://doi.org/10.1016/j.jvs.2015.01.061
- STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499https://doi.org/10.1016/j.ijsu.2014.07.013
- Vascular resection during pancreatectomy for pancreatic head cancer: a technical issue or a prognostic sign?.Surgery. 2021; 169: 403-410https://doi.org/10.1016/j.surg.2020.08.002
- Pancreaticoduodenectomy: superior mesenteric artery first approach.J Gastrointest Surg. 2006; 10: 607-611https://doi.org/10.1016/j.gassur.2005.05.001
- Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival.Br J Surg. 2018 May; 105: 628-636
- Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis.Hepatobiliary Pancreat Dis Int. 2017 Apr; 16: 127-138
- NCCN guidelines updates: pancreatic cancer.J Natl Compr Cancer Netw. 2019; 17: 603-605https://doi.org/10.6004/jnccn.2019.5007
- International study group on pancreatic surgery (ISGPS). The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.Surgery. 2017; 161: 584-591https://doi.org/10.1016/j.surg.2016.11.014
- Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery.Surgery. 2011; 149: 680-688https://doi.org/10.1016/j.surg.2010.12.002
- Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition.Surgery. 2007; 142: 20-25https://doi.org/10.1016/j.surg.2007.02.001
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
- Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality.Ann Surg. 2015; 262: 1071-1078https://doi.org/10.1097/SLA.0000000000001048
- 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers.Ann Surg Oncol. 2018 Apr; 25: 845-847https://doi.org/10.1245/s10434-017-6025-x
- Redefining the R1 resection in pancreatic cancer.Br J Surg. 2006; 93: 1232-1237https://doi.org/10.1002/bjs.5397
- Defining benchmark outcomes for pancreatoduodenectomy with portomesenteric venous resection.Ann Surg. 2020 Nov; 272 (PMID: 32889866): 731-737https://doi.org/10.1097/SLA.0000000000004267
- Outcomes following pancreatic surgery using three different thromboprophylaxis regimens.Br J Surg. 2019; 106: 765-773https://doi.org/10.1002/bjs.11103
Article info
Publication history
Published online: April 06, 2023
Accepted:
March 24,
2023
Received in revised form:
February 13,
2023
Received:
November 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
