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11-11-2023 | Pancreatectomy | Pancreatic Tumors

Technical Strategy for Pancreatic Body Cancers: A Raison d'etre of Distal Pancreatectomy with Portal Resection

Authors: Aya Maekawa, MD, PhD, Atsushi Oba, MD, PhD, Yosuke Inoue, MD, PhD, Kojiro Omiya, MD, Yoshihiro Ono, MD, PhD, Takafumi Sato, MD, PhD, Shuichi Watanabe, MD, PhD, Yoshihiro Uchino, MD, PhD, Kosuke Kobayashi, MD, PhD, Hiromichi Ito, MD, FACS, Yozo Sato, MD, PhD, Minoru Tanabe, MD, PhD, Akio Saiura, MD, PhD, Yu Takahashi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2024

Abstract

Background

Advancements in multiagent chemotherapy have expanded the surgical indications for pancreatic cancer. Although pancreaticoduodenectomy (PD) with portal vein resection (PVR) has become widely adopted, distal pancreatectomy (DP) with PVR remains rarely performed because of its technical complexity. This study was designed to assess the feasibility of DP-PVR compared with PD-PVR for pancreatic body cancers, with a focus on PV complications and providing optimal reconstruction techniques when DP-PVR is necessary.

Methods

A retrospective review was conducted on consecutive pancreatic body cancer patients who underwent pancreatectomy with PVR between 2005 and 2020. An algorithm based on the anatomical relationship between the arteries and PV was used for optimal surgical selection.

Results

Among 119 patients, 32 underwent DP-PVR and 87 underwent PD-PVR. Various reconstruction techniques were employed in DP-PVR cases, including patch reconstruction, graft interposition, and wedge resection. The majority of PD-PVR cases involved end-to-end anastomosis. The length of PVR was shorter in DP-PVR (25 vs. 40 mm; p < 0.001). Although Clavien-Dindo ≥3a was higher in DP-PVR (p = 0.002), inpatient mortality and R0 status were similar. Complete PV occlusion occurred more frequently in DP-PVR than in PD-PVR (21.9% vs. 1.1%; p < 0.001). A cutoff value of 30 mm for PVR length was determined to be predictive of nonrecurrence-related PV occlusion after DP-PVR. The two groups did not differ significantly in recurrence or overall survival.

Conclusions

DP-PVR had higher occlusion and postoperative complication rates than PD-PVR. These findings support the proposed algorithm and emphasize the importance of meticulous surgical manipulation when DP-PVR is deemed necessary.

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Title: Technical Strategy for Pancreatic Body Cancers: A Raison d'etre of Distal Pancreatectomy with Portal Resection
Authors: Aya Maekawa, MD, PhD
Atsushi Oba, MD, PhD
Yosuke Inoue, MD, PhD
Kojiro Omiya, MD
Yoshihiro Ono, MD, PhD
Takafumi Sato, MD, PhD
Shuichi Watanabe, MD, PhD
Yoshihiro Uchino, MD, PhD
Kosuke Kobayashi, MD, PhD
Hiromichi Ito, MD, FACS
Yozo Sato, MD, PhD
Minoru Tanabe, MD, PhD
Akio Saiura, MD, PhD
Yu Takahashi, MD, PhD
Publication date: 11-11-2023
Publisher: Springer International Publishing
Keyword: Pancreatectomy
Published in: Annals of Surgical Oncology / Issue 2/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14554-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Technical Strategy for Pancreatic Body Cancers: A Raison d'etre of Distal Pancreatectomy with Portal Resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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