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.
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.
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).
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.
[Show abstract][Hide abstract] ABSTRACT: Pancreatic ductal adenocarcinoma is a devastating disease with extremely poor survival despite patients undergoing potentially curative resections and improvements in chemotherapeutic agents. Surgery for operable cancer in the head of the pancreas typically involves an open pancreaticoduodenectomy with a post-operative median survival of 21 months. Newer surgical techniques, however, aim to improve patient outcomes in terms of both their hospital experience and better oncological results. This article focuses on the evidence to date for some of these surgical techniques including laparoscopic and robotic surgery, the no-touch technique, venous and arterial resection, intra-operative radiofrequency ablation and intra-operative irreversible electroporation. With the increased use of these techniques we hope to see better quality of life and survival for these patients.
Expert Review of Gastroenterology and Hepatology 02/2014; DOI:10.1586/17474124.2014.881251 · 2.42 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Background
Pancreaticoduodenectomy combined with portal-superior mesenteric vein synchronous resection for cancer remains a hot debate topic. The present study used meta-analytical technique to provide update information and an evidence-based evaluation on both the perioperative benefit and long-term survival..
A meta-analysis was performed to evaluate studies comparing venous resection (VR) versus without venous resection (WVR) groups. 22 retrospective studies including 2890 patients were eligible for an analysis of perioperative morbidity, mortality, and long-term survival. Furthermore, subgroup analysis was made according to histopathology and resection margin status respectively for the purpose of survival assessment.
There was no difference in perioperative morbidity, mortality and 1-year, 3-year survival between two groups, but showed differences in median tumor size (P<0.001), R0 resection rate (P<0.001), lymph node metastasis (P=0.03), pancreatic fistula (P=0.01), and 5-year survival (P=0.03). In subgroup analysis, patients in venous resection group received R0 resection had a significantly better survival comparing with who received R1 resection both at 2-year (P<0.001) and 5-year (P=0.00002). In histopathology subgroup, patients in venous resection groups who had true tumor infiltration had a significantly bad survival comparing with whom only with inflammation pathology.
Pancreaticoduodenectomy combined with venous resection can achieve equal perioperative morbidity and mortality as standard resection. However, in order to obtain an optimal survival outcome, surgeons should make a R0 resection as far as possible, especially in cases need synchronous venous resection.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 04/2014; 40(4). DOI:10.1016/j.ejso.2014.01.010 · 3.01 Impact Factor
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