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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2015

01-06-2015 | Pancreatic Tumors

Pancreatic Adenocarcinoma with Venous Involvement: Is Up-Front Synchronous Portal-Superior Mesenteric Vein Resection Still Justified? A Survey of the Association Française de Chirurgie

Authors: Jean Robert Delpero, MD, Jean Marie Boher, PhD, Alain Sauvanet, MD, Yves Patrice Le Treut, MD, Antonio Sa-Cunha, MD, Jean Yves Mabrut, MD, Laurence Chiche, MD, Olivier Turrini, MD, Philippe Bachellier, MD, François Paye, MD

Published in: Annals of Surgical Oncology | Issue 6/2015

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Abstract

Background

Venous resection (VR) during pancreatectomy has been reported to neither increase mortality nor morbidity and to provide similar survival outcomes in same stage tumors. However, controversy remains regarding the indications for up-front surgery according to the degree of venous involvement.

Methods

From 2004 to 2009, 1,399 patients included in a French multicenter survey underwent pancreaticoduodenectomy or total pancreatectomy for pancreatic adenocarcinoma, either without VR (997 standard resections [SR]) or with VR (402 patients; 29 %). Postoperative and long-term outcomes were compared in both groups.

Results

VR was associated with the following factors: larger tumors (p < 0.001), poorly differentiated tumors (p = 0.004), higher numbers of positive lymph nodes (p = 0.042), and positive resection margins (R1; p < 0.001). Overall, VR increased neither postoperative morbidity nor postoperative mortality (5 vs. 3 % in SR patients; p = 0.16). The median and 3-year survival rates in VR patients versus SR patients were 21 months and 31 % vs. 29 months and 44 %, respectively (p = 0.0002). In the entire cohort, multivariate analysis identified VR as a significant poor prognostic factor for long-term survival (hazard ratio [HR] 1.75, 95 % confidence interval [CI] 1.28–2.40; p = 0.0005). In the VR patients, lymph node ratio, whatever the cutoff (<0.3: p = 0.093; ≥0.3: p = 0.0098), R1 resection (p = 0.010), and segmental resection (p = 0.016) were independent risk factors; neoadjuvant treatment (HR 0.52, 95 % CI 0.29–0.94; p = 0.031) and adjuvant treatment (HR 0.55, 95 % CI 0.35–0.85; p = 0.006) were significantly associated with improved long-term survival.

Conclusions

Long-term survival after pancreatectomy was significantly altered when up-front VR was performed. Neoadjuvant treatment may be a better strategy than up-front resection in patients with preoperative suspicion of venous involvement.
Appendix
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Metadata
Title
Pancreatic Adenocarcinoma with Venous Involvement: Is Up-Front Synchronous Portal-Superior Mesenteric Vein Resection Still Justified? A Survey of the Association Française de Chirurgie
Authors
Jean Robert Delpero, MD
Jean Marie Boher, PhD
Alain Sauvanet, MD
Yves Patrice Le Treut, MD
Antonio Sa-Cunha, MD
Jean Yves Mabrut, MD
Laurence Chiche, MD
Olivier Turrini, MD
Philippe Bachellier, MD
François Paye, MD
Publication date
01-06-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 6/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4304-3

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