Pancreatectomy with venous resection for pT3 head adenocarcinoma: Perioperative outcomes, recurrence pattern and prognostic implications of histologically confirmed vascular infiltration

Giuseppe Malleo; Laura Maggino; Giovanni Marchegiani; Giovanni Feriani; Alessandro Esposito; Luca Landoni; Luca Casetti; Salvatore Paiella; Elda Baggio; Giovanni Lipari; Paola Capelli; Aldo Scarpa; Claudio Bassi; Roberto Salvia

doi:10.1016/j.pan.2017.08.005

Pancreatectomy with venous resection for pT3 head adenocarcinoma: Perioperative outcomes, recurrence pattern and prognostic implications of histologically confirmed vascular infiltration

Pancreatology. 2017 Sep-Oct;17(5):847-857. doi: 10.1016/j.pan.2017.08.005. Epub 2017 Aug 19.

Affiliations

¹ Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy. Electronic address: giuseppe.malleo@aovr.veneto.it.
² Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy.
³ Unit of Vascular Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Italy.
⁴ Department of Pathology and Diagnostics, University of Verona Hospital Trust, Italy.
⁵ Department of Pathology and Diagnostics, University of Verona Hospital Trust, Italy; ARC-NET Research Center, University of Verona Hospital Trust, Italy.

PMID: 28843714
DOI: 10.1016/j.pan.2017.08.005

Abstract

Background: The outcomes of pancreatectomy with superior mesenteric vein (SMV) or portal vein (PV) resection have been mixed. This study investigated the morbidity and mortality profile after SMV-PV resection in comparison with standard pancreatectomy. Furthermore, we assessed whether tumors with histologically proven SMV-PV infiltration differ from other pT3 neoplasms in terms of recurrence pattern and survival.

Methods: All patients with a pT3 head adenocarcinoma resected from 2000 to 2013 were analyzed retrospectively. In the SMV-PV resection group, information on venous wall status was obtained through pathologic reports. Standard statistical methods were used for data analysis.

Results: The study population consisted of 651 patients, of whom 81 (12.4%) underwent synchronous SMV-PV resection. Venous resection was not associated with a higher rate of postoperative complications (60.5% versus 50.2%) and mortality (1.2% versus 1.1%) in comparison with standard pancreatectomy. Vascular infiltration was confirmed pathologically in 56/81 patients (69.1%). The median disease-specific survival of the entire population was 27 months (95% CI 24.6-29.3), with a 5-year survival rate of 20.5%. The median recurrence-free survival was 18 months (95% CI 15.0-20.9). On multivariate analysis, ASA score, preoperative pain, Ca 19-9 levels, tumor grade, R-status, lymph-vascular invasion, N-status, and adjuvant therapy resulted to be survival predictors. Similarly, Ca 19.9 levels, R-status, and N-status were predictors of recurrence. SMV-PV infiltration was not a significant prognostic factor.

Conclusion: Morbidity and mortality rates of pancreatectomy with SMV-PV resection are comparable with standard pancreatectomy. Pancreatic head adenocarcinoma with histologically confirmed SMV-PV infiltration does not segregate prognostically from other pT3 tumors.

Keywords: Pancreatic cancer; Pancreaticoduodenectomy; Portal/superior mesenteric vein resection; Post-operative complications; Survival.

MeSH terms

Aged
Female
Humans
Male
Mesenteric Veins / pathology*
Middle Aged
Neoplasm Recurrence, Local / pathology
Pancreatectomy*
Pancreatic Neoplasms / classification*
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / surgery*
Perioperative Period
Postoperative Complications
Prognosis
Retrospective Studies
Survival Rate
Treatment Outcome