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1
Queens MEdical Centre, Nottingham, United Kingdom
2
Leicester General Hospital, Leicester, United Kingdom
Abstract citation ID: znac404.144
HPB P49 Vein wall invasion is a more reliable predictor of
oncological outcomes than vein related surgical margins after
pancreaticoduodenectomy for early stages of pancreatic ductal
adenocarcinoma
Manish Ahuja, Rupaly Pande, Syed Soulat Raza, David C Bartlett,
Bobby Dasari, Ravi Marudanayagam, Darius Mirza, Keith John Roberts,
John Issac, Robert P Sutcliffe, Nikolaos A Chatzizacharias
Queen Elizabeth Hospital, Birmingham, United Kingdom
Background: Pancreaticoduodenectomy (PD) with vein resection is the
only potentially curative option for patients with pancreatic ductal
adenocarcinoma (PDAC) with venous involvement. The aim of our
study was to assess the oncological prognostic significance of the
different variables of venous involvement in patients undergoing PD
for resectable and borderline resectable with venous only involvement
(BR-V) PDAC.
Methods: Retrospective analysis of prospectively maintained PD
database from 2011–2020 was performed. Standard descriptive
statistical analysis; statistical comparisons with the use of the
appropriate test; survival analysis with the Kaplan-Meier method and
log rank test for overall survival (OS), disease-free survival (DFS) and
local recurrence (LR); risk analysis for separate surgicalmargins with
univariable and multivariable Cox proportional hazard model were used.
Results: One hundred and five of 372 patients (28%) required vein
resection and vein wall involvement was identified in 37% of those.
More vein resections were performed in female patients and as
expected for BR-V disease.
OS, DFS and LR were significantly longer after R0 resection, irrespective
of the need for a venous resection. Following analysis of separate surgical
margins,theveingrooveandtheveintransectionmargins(thelatteronly
applicable in patients that had a venous resection) were not identified as
predictors of oncological outcomes. On the contrary, vein wall invasion
was an independent predictor of OS (HR:1.947, CI: 1.228–3.089, p=0.005),
DFS (HR: 2.169, CI: 1.306–3.602, p=0.003) and LR (HR: 2.365, CI: 1.089–5.133,
p=0.030) after PD with venous resection.
Conclusions: Vein wall tumour invasion may be a more reliable
predictor of oncological outcomes compared to traditionally reported
parameters. Future studies should focus on possible pre-operative
investigations that could identify these cases and management
pathways that could yield survival benefit, such as the use of
neoadjuvant treatments.
ix54 | Abstracts