Tu1622 Portal Venous Resection in Cancer of the Pancreatic Head: What Are the Relevant Predictors of Survival?

432 Background: Guidelines recommend pancreatic protocol CT scan (CT) for staging vascular involvement in patients with pancreatic cancer (PC). While endoscopic ultrasound (EUS) has been demonstrated to be effective in venous staging of PC, its role when combined with CT is poorly defined. We evaluated the utility of EUS in addition to CT in staging PC. We hypothesized that EUS complements CT in identifying SMV/PV tumor involvement as measured by the requirement for vein resection. Methods: We reviewed our database of patients with borderline resectable PC who went to surgery with curative intent. Inclusion criteria were pre-operative staging with CT scan, EUS, PET scan, and CA 19-9 levels, as well as completion of neoadjuvant chemotherapy and radiation. Results: We identified 62 patients with 74% of tumors in the pancreatic head. 97% of resections were R0. The average age was 65 ± 9 years; 60% were male. Patients were classified as borderline resectable by EUS alone in 29%, CT alone in 23%, and both modalities in 48% of patients, respectively. 34 patients required vein resection; EUS identified 88% of these patients pre-operatively while CT identified 68%. EUS identified 11 patients who required vein resection that CT did not identify while CT identified 4 patients that EUS did not identify. EUS had higher sensitivity and specificity than CT in identifying patients requiring venous resection (Table). On multivariate logistic regression analysis, EUS was predictive of vein resection (P < 0.02) but CT scan findings, PET scan findings, tumor size, and CA19-9 values were not predictive (each P > 0.1). In margin negative resected patients, median survival was longer when both CT and EUS identified borderline status compared to only 1 modality (43 vs 23 months, P < 0.05). Conclusions: EUS complemented CT in identifying patients with borderline resectable PC requiring vein resection- 29% of patients were identified with EUS alone. This observation supports the use of EUS in addition to CT scan for the vascular staging of patients with PC. [Table: see text]

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Benefit of venous resection for ductal adenocarcinoma of the pancreatic head

The European Journal of Surgery ◽

10.1080/00000000000000007 ◽

2002 ◽

Vol 168 (12) ◽

pp. 707-712 ◽

Cited By ~ 53

Author(s):

Mark Hartel ◽

Marco Niedergethmann ◽

Michael Farag-Soliman ◽

Jörg Sturm ◽

Axel Richter ◽

...

Keyword(s):

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

Venous Resection

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Results of venous resections in cancer of the pancreatic head.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16785 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16785-e16785

Author(s):

Oleg I. Kit ◽

Oksana V. Katelnitskaya ◽

Andrey A. Maslov ◽

Aleksey Yu. Maksimov ◽

Evgeniy N. Kolesnikov ◽

...

Keyword(s):

Pancreatic Head ◽

Pathological Examination ◽

Additional Risk Factor ◽

Incomplete Resection ◽

Sleeve Resection ◽

Venous Resection ◽

Advantages And Disadvantages ◽

Ductal Pancreatic Adenocarcinoma ◽

Direct Anastomosis ◽

Venous Segment

e16785 Background: Studies have shown that pancreaticoduodenal resection (PDR) with resection and reconstruction of the venous segment does not interfere with surgical treatment for ductal pancreatic adenocarcinoma with suspected venous invasion. Venous resection improves survival compared to palliative interventions. However, the advantages and disadvantages of marginal resection, segmental resection with direct anastomosis, and venous segment prosthetics are not reflected. Methods: The study included 52 patients (23 women, 29 men) undergoing PDR with venous resection and reconstruction for cancer of the pancreatic head in 2015-2019. The average tumor size was 3.8 cm. Results: Superior mesenteric vein reconstruction (PTFE grafts) was performed in 17 patients (32.7%), sleeve resection with direct anastomosis - 24 (46.2%), marginal resection - 11 (21.1%). Venous reconstruction was planned in 78.8% of patients before the surgery. In the early postoperative period, thrombosis of the reconstructed zone was developed in two patients (3.8%), bleeding from the pancreatic bed - in one case (1.9%). Postoperative mortality was 5.8% (3 patients). After the final pathological examination, macroscopically incomplete resection was diagnosed only in the group with marginal resection and amounted to 3.8%. Microscopically incomplete resection was diagnosed in 9.6% of the studied preparations (in marginal resection of the vein wall - 3.8%, with direct anastomosis - 1.9%, SMV prosthetics - 3.8%). Most often, R1 resection was detected in the retroperitoneal resection margin (80%). The lowest 1-year survival was observed in the group with marginal resection (36.4%). No significant differences in survival rates were found in patients with direct venous anastomosis (62.5%) and venous prosthetics (64.7%) (RR 1.69; 95% CI 0.69-4.12, p > 0.05). Microscopically complete resection R0 improved the survival (RR 2.7; 95% CI 1.45-5.04, p < 0.05). Planning the venous resection was an additional risk factor affecting the completeness of resection (RR 4.6; CI 95% 1.5-14.5, p > 0.05). Conclusions: Expanding the surgery volume in PDR due to venous resection and reconstruction shows acceptable rates of postoperative morbidity and mortality. Planning the venous resection enhances the results of radical surgery.

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Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: Prognostic value of the length of venous resection

Surgery ◽

10.1016/j.surg.2008.12.009 ◽

2009 ◽

Vol 145 (4) ◽

pp. 417-425 ◽

Cited By ~ 78

Author(s):

Yuji Kaneoka ◽

Akihiro Yamaguchi ◽

Masatoshi Isogai

Keyword(s):

Prognostic Value ◽

Superior Mesenteric Vein ◽

Pancreatic Head ◽

Venous Resection ◽

Mesenteric Vein ◽

Vein Resection

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Pancreatoduodenectomy with Simultaneous Venous Resection for Advanced Ductal Pancreatic Head Cancer: A Case Control Study

Surgical Science ◽

10.4236/ss.2018.911045 ◽

2018 ◽

Vol 09 (11) ◽

pp. 381-398

Author(s):

Philipp R. Scherber ◽

Jurgita Mikneviciute ◽

Gereon Gäbelein ◽

Dorian Igna ◽

Matthias Glanemann

Keyword(s):

Case Control Study ◽

Pancreatic Head ◽

Case Control ◽

Venous Resection ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Control Study

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PANCREATICODUODENECTOMY WITH VENOUS RESECTION: AN ANALYSIS OF 30-DAY MORBIDITY AND MORTALITY

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-46 ◽

2019 ◽

Vol 56 (3) ◽

pp. 246-251

Author(s):

Guilherme Hoverter CALLEJAS ◽

Matheus Mathedi CONCON ◽

Achiles Queiroz Monteiro de REZENDE ◽

Elinton Adami CHAIM ◽

Francisco CALLEJAS-NETO ◽

...

Keyword(s):

Pancreatic Head ◽

Morbidity And Mortality ◽

University Hospital ◽

Ductal Adenocarcinoma ◽

Perioperative Outcomes ◽

Perioperative Mortality ◽

Historical Cohort ◽

Venous Resection ◽

Perioperative Morbidity ◽

Adenocarcinoma Of The Pancreas

ABSTRACT BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.

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Hind Right Approach Pancreaticoduodenectomy: From Skill to Indications

Gastroenterology Research and Practice ◽

10.1155/2014/210835 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Stefan Georgescu ◽

Corina Ursulescu ◽

Valentin Titus Grigorean ◽

Cristian Lupascu

Keyword(s):

Hepatic Artery ◽

Pancreatic Head ◽

The Body ◽

Vascular Control ◽

Intraductal Papillary Mucinous Neoplasms ◽

Venous Resection ◽

Mucinous Neoplasms ◽

Anatomic Variants ◽

Mesenteric Vessels ◽

Periampullary Region

Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results.Methods. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection.Results. We used this approach in 52 patients. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed. In nine patients with intraductal papillary mucinous neoplasms the pancreaticoduodenectomy was extended to the body in 6 and totalized in 3 patients. Seven patients with adenocarcinoma involving the portomesenteric axis required venous resection and reconstruction.Conclusions. Early hind right approach is advocated in selected cases of pancreaticoduodenectomy to improve locoregional vascular control and determine, safely and early, whether there is mesopancreas involvement.

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