Benefit of portal or superior mesenteric vein resection with adjuvant chemotherapy for patients with pancreatic head carcinoma
ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of portal or superior mesenteric vein (PV/SMV) resection for patients with pancreatic carcinoma who underwent pancreatoduodenectomy. METHODS: Medical records of 125 patients with pancreatic head carcinoma who underwent pancreatoduodenectomy were reviewed retrospectively. Sixty-one patients underwent PV/SMV resection and 64 patients did not. Clinicopathological factors were compared between the two groups and the prognostic impact of PV/SMV resection was evaluated using univariate and multivariate survival analysis. RESULTS: The frequency of mortality and morbidity did not differ between the two groups. Univariate analysis revealed that a significant difference in overall survival was found between patients who did and did not undergo PV/SMV resection (P = 0.046) as well as between patients with and without pathological PV/SMV invasion (P = 0.012). However, PV/SMV resection and pathological PV/SMV invasion were not independent prognostic factors by multivariate survival analysis. Among patients with PV/SMV resection, the use of adjuvant chemotherapy was the only independent prognostic factor of overall survival (P = 0.003). CONCLUSIONS: Resection of the PV/SMV with adjuvant chemotherapy may provide an acceptable survival benefit to patients with pancreatic head carcinoma, which involves the PV/SMV without additional mortality and morbidity. J. Surg. Oncol © 2012 Wiley Periodicals, Inc.
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ABSTRACT: Pancreatic fistula (PF) is one of the leading complications after pancreatic resection for pancreatic carcinoma. The aim of this study was to determine whether PF was associated with deterioration of long-term outcomes in patients with pancreatic carcinoma after surgical resection. Medical records of 210 patients with pancreatic carcinoma who underwent tumor resection were reviewed retrospectively. PF was defined as grade B or C PF according to the criteria of the International Study Group on Pancreatic Fistula. Clinicopathological factors including overall survival were compared between patients with and without PF by univariate and multivariate analyses. Thirty-one patients (15 %) developed postoperative PF, and 179 (85 %) did not. The 31 cases of PF consisted of 27 grade B PF and 4 grade C PF. There were no differences in the use of adjuvant chemotherapy, tumor differentiation, lymph node status, surgical margin status, or UICC stage between groups. Overall 5-year survival rates for patients with and without PF were 25 and 27 %, respectively. There was no significant difference in overall survival between the two groups (P = 0.743). Multivariate analysis demonstrated that the use of postoperative adjuvant chemotherapy (P < 0.001), tumor differentiation (P = 0.005), and lymph node metastasis (p < 0.001) were factors independently associated with overall survival. These results suggested that PF was not associated with deterioration of long-term outcomes in patients with pancreatic carcinoma. However, further analyses on larger number of patients are needed to determine a negative effect of grade C PF on long-term survival.World Journal of Surgery 10/2014; 39(2). DOI:10.1007/s00268-014-2823-5 · 2.35 Impact Factor
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ABSTRACT: Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial. Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD-VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed. Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD-VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD-VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD-VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival. PD with VR has similar morbidity but worse OS compared with a PD-VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.Annals of Surgical Oncology 02/2014; 21(6). DOI:10.1245/s10434-014-3554-4 · 3.94 Impact Factor
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ABSTRACT: Background and Objectives Venous resection of locally advanced pancreatic cancer is associated with increased morbidity and mortality; therefore identification of patients most likely to benefit from this aggressive surgical approach is an important goal. Loss of SMAD4 staining on resected specimens has been associated with outcomes. Few studies have evaluated the prognostic significance of SMAD4 staining of pre-operative cell blocks, which would be useful in clinical decision making for patients with locally advanced disease.Methods Clinical data were retrospectively evaluated from all patients undergoing pancreaticoduodenectomy with venous resection. Immunohistochemical staining for SMAD4 was performed on pre-operative cell blocks and subsequent post-operative resections.ResultsOne hundred seventeen patients underwent pancreaticoduodenectomy with venous resection. Sixty had sufficient specimens available for SMAD4 staining. SMAD4 loss was observed in 70% of resections and was associated with earlier time to metastatic disease. Pre-operative SMAD4 loss correlated well with post-operative staining and was associated with six times higher likelihood of developing metastases.Conclusion In this pilot study, preoperative SMAD4 staining showed a strong correlation with postoperative staining and predicted metastases in locally advanced cancer. Preoperative SMAD4 status may be considered as one of several factors when selecting patients most likely to benefit from aggressive en bloc venous resection. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.Journal of Surgical Oncology 08/2014; 110(2). DOI:10.1002/jso.23606 · 2.84 Impact Factor