Clinical significance of portal or superior mesenteric vein invasion during pancreaticoduodenectomy for pancreatic adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN Haoyuan ¹ , MAI Gang ¹ , KE Nengwen ² ,  LIU Xubao ²

1. Department of Gastrointestinal Surgery, People’s Hospital of Deyang, Deyang, Sichuan 618000, P. R. China;
2. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LIU Xubao, Email: xbliu@medmail.com.cn

Keywords：

pancreatic adenocarcinoma; pancreaticoduodenectomy; portal vein; superior mesenteric vein; postoperative adjuvant chemotherapy

DOI：

10.7507/1007-9424.202101004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effect of pathological portal vein (PV)/superior mesenteric vein (SMV) invasion during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma and the clinical significance of PD with PV/SMV resection in patients without pathological evidence of venous invasion.Methods From January 1, 2013 to December 31, 2017, data of 183 patients who had PD for pancreatic adenocarcinoma were collected. Eighty-one patients had PD with PV/SMV resection for pancreatic adenocarcinoma, among them, 42 cases (51.9%) had pathological PV/SMV invasion (PD+P/S⁺ group) and 39 patients (48.1%) didn’t have pathological PV/SMV invasion (PD+P/S⁻ group). One hundred and two patients had a standard PD without PV/SMV resection (control group). Multivariate analysis was used to identify predictive variables which influencing survival and the Kaplan-Meier method to estimate patients’ survival.Results There were no differences in gender, age, preoperative serum CA19-9 level, blood loss, tumor size, tumor TNM stage, positive lymph nodes, ratio of positive lymph nodes, degree of tumor differentiation, perineural invasion, postoperative adjuvant chemotherapy, type of operation, and margin status among 3 groups (P>0.05). And moreover, no significant differences were found between the PD combined PV/SMV resection group and the control group in the incidence of complications and mortality (P>0.05) and all no reoperation happened. Univariate analysis revealed a significant difference in overall survival (OS) among the PD+P/S⁺ group, PD+P/S^– group and control group (P<0.001), median survival time were 10, 19 and 20 months, respectivly. Moreover, depth of PV/SMV invasion, use of postoperative adjuvant chemotherapy and tumor differentiation were independent prognostic factors by multivariate survival analysis.Conclusions OS of patients with PV/SMV invasion is significantly worse than that of patients without PV/SMV invasion, no matter underwent PV/SMV resection or not. The cause of that maybe invade to the tunica intima by tumor limits OS of patients with pancreatic adenocarcinoma. OS of PV/SMV-resected patients without pathological PV/SMV invasion is similar to that of patients who had standard PD without PV/SMV resection. Whether the patients can benefit from routine resection of PV/SMV is still controversial.

Citation： REN Haoyuan, MAI Gang, KE Nengwen, LIU Xubao. Clinical significance of portal or superior mesenteric vein invasion during pancreaticoduodenectomy for pancreatic adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(10): 1301-1307. doi: 10.7507/1007-9424.202101004 Copy

1.	柯能文, 刘续宝. 胰腺癌外科治疗华西10年经验. 中国普外基础与临床杂志, 2021, 28(1): 4-7.
2.	Buchs NC, Chilcott M, Poletti PA, et al. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol, 2010, 16(7): 818-831.
3.	Ravikumar R, Sabin C, Abu Hilal M, et al. Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg, 2014, 218(3): 401-411.
4.	Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
5.	Tang D, Zhang JQ, Wang DR. Long term results of pancreatectomy with portal-superior mesenteric vein resection for pancreatic carcinoma: A systematic review. Hepatogastroenterology, 2011, 58(106): 623-631.
6.	Riediger H, Makowiec F, Fischer E, et al. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg, 2006, 10(8): 1106-1115.
7.	Banz VM, Croagh D, Coldham C, et al. Factors influencing outcome in patients undergoing portal vein resection for adenocarcinoma of the pancreas. Eur J Surg Oncol, 2012, 38(1): 72-79.
8.	Bell R, Ao BT, Ironside N, et al. Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival. Surg Oncol, 2017, 26(1): 53-62.
9.	Gong Y, Zhang L, He T, et al. Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis. PLoS One, 2013, 8(8): e70340.
10.	Castleberry AW, White RR, De La Fuente SG, et al. The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Ann Surg Oncol, 2012, 19(13): 4068-4077.
11.	Heinemann V, Haas M, Boeck S. Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer. Ann Oncol, 2013, 24(10): 2484-2492.
12.	Giovinazzo F, Turri G, Katz MH, et al. Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg, 2016, 103(3): 179-191.
13.	Han SS, Park SJ, Kim SH, et al. Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer. Pancreas, 2012, 41(1): 102-106.
14.	Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
15.	Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg, 2009, 13(4): 784-792.
16.	Roch AM, House MG, Cioffi J, et al. Significance of portal vein invasion and extent of invasion in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg, 2016, 20(3): 479-487.
17.	Rehders A, Stoecklein NH, Güray A, et al. Vascular invasion in pancreatic cancer: tumor biology or tumor topography? Surgery, 2012, 152(3 Suppl 1): S143-S151.
18.	Nakagohri T, Kinoshita T, Konishi M, et al. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg, 2003, 186(2): 149-153.
19.	Fukuda S, Oussoultzoglou E, Bachellier P, et al. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg, 2007, 142(2): 172-179.
20.	Boggi U, Del Chiaro M, Croce C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery, 2009, 146(5): 869-881.
21.	Murakami Y, Satoi S, Motoi F, et al. Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg, 2015, 102(7): 837-846.
22.	Wang J, Estrella JS, Peng L, et al. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage Ⅱ pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer, 2012, 118(15): 3801-3811.
23.	Lapshyn H, Bronsert P, Bolm L, et al. Prognostic factors after pancreatoduodenectomy with en bloc portal venous resection for pancreatic cancer. Langenbecks Arch Surg, 2016, 401(1): 63-69.
24.	Ramacciato G, Nigri G, Petrucciani N, et al. Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol, 2016, 23(6): 2028-2037.
25.	Mierke F, Hempel S, Distler M, et al. Impact of portal vein involvement from pancreatic cancer on metastatic pattern after surgical resection. Ann Surg Oncol, 2016, 23(Suppl 5): 730-736.
26.	Murakami Y, Uemura K, Sudo T, et al. Benefit of portal or superior mesenteric vein resection with adjuvant chemotherapy for patients with pancreatic head carcinoma. J Surg Oncol, 2013, 107(4): 414-421.
27.	Turrini O, Ewald J, Barbier L, et al. Should the portal vein be routinely resected during pancreaticoduodenectomy for adenocarcinoma? Ann Surg, 2013, 257(4): 726-730.
28.	Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer, 2010: 241.
29.	Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2014, 155(6): 977-988.
30.	Campbell F, Feakins R. Dataset for the histopathological reporting of carcinomas of the pancreas, ampulla of vater and common bile duct. London: Royal College of Pathologists, 2017: 17-18.
31.	柯能文, 刘续宝. 胰十二指肠切除术在胰头癌治疗中的应用与进展. 中国普外基础与临床杂志, 2019, 26(4): 385-388.
32.	Murakami Y, Uemura K, Sudo T, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg, 2008, 195(6): 757-762.
33.	Murakami Y, Uemura K, Sudo T, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol, 2012, 106(2): 174-180.
34.	Adham M, Jaeck D, Le Borgne J, et al. Long-term survival (5–20 years) after pancreatectomy for pancreatic ductal adenocarcinoma: a series of 30 patients collected from 3 institutions. Pancreas, 2008, 37(4): 352-357.
35.	Bissolati M, Sandri MT, Burtulo G, et al. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer. Tumour Biol, 2015, 36(2): 991-996.
36.	Kim J, Reber HA, Dry SM, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut, 2006, 55(11): 1598-1605.
37.	Van den Broeck A, Sergeant G, Ectors N, et al. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol, 2009, 35(6): 600-604.
38.	Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg, 2004, 8(8): 935-949.
39.	Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs. gemcitabine followed pancreatic cancer resection: a randomized controlled trial. JAMA, 2010, 304(10): 1073-1081.
40.	Shi S, Yu X. Selecting chemotherapy for pancreatic cancer: far away or so close? Semin Oncol, 2019, 46(1): 39-47.
41.	奚士航, 王小明. 胰腺癌新辅助化疗的应用现状及进展. 中国普外基础与临床杂志, 2020, 27(2): 226-231.

1. 柯能文, 刘续宝. 胰腺癌外科治疗华西10年经验. 中国普外基础与临床杂志, 2021, 28(1): 4-7.
2. Buchs NC, Chilcott M, Poletti PA, et al. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol, 2010, 16(7): 818-831.
3. Ravikumar R, Sabin C, Abu Hilal M, et al. Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg, 2014, 218(3): 401-411.
4. Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
5. Tang D, Zhang JQ, Wang DR. Long term results of pancreatectomy with portal-superior mesenteric vein resection for pancreatic carcinoma: A systematic review. Hepatogastroenterology, 2011, 58(106): 623-631.
6. Riediger H, Makowiec F, Fischer E, et al. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg, 2006, 10(8): 1106-1115.
7. Banz VM, Croagh D, Coldham C, et al. Factors influencing outcome in patients undergoing portal vein resection for adenocarcinoma of the pancreas. Eur J Surg Oncol, 2012, 38(1): 72-79.
8. Bell R, Ao BT, Ironside N, et al. Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival. Surg Oncol, 2017, 26(1): 53-62.
9. Gong Y, Zhang L, He T, et al. Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis. PLoS One, 2013, 8(8): e70340.
10. Castleberry AW, White RR, De La Fuente SG, et al. The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Ann Surg Oncol, 2012, 19(13): 4068-4077.
11. Heinemann V, Haas M, Boeck S. Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer. Ann Oncol, 2013, 24(10): 2484-2492.
12. Giovinazzo F, Turri G, Katz MH, et al. Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg, 2016, 103(3): 179-191.
13. Han SS, Park SJ, Kim SH, et al. Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer. Pancreas, 2012, 41(1): 102-106.
14. Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
15. Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg, 2009, 13(4): 784-792.
16. Roch AM, House MG, Cioffi J, et al. Significance of portal vein invasion and extent of invasion in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg, 2016, 20(3): 479-487.
17. Rehders A, Stoecklein NH, Güray A, et al. Vascular invasion in pancreatic cancer: tumor biology or tumor topography? Surgery, 2012, 152(3 Suppl 1): S143-S151.
18. Nakagohri T, Kinoshita T, Konishi M, et al. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg, 2003, 186(2): 149-153.
19. Fukuda S, Oussoultzoglou E, Bachellier P, et al. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg, 2007, 142(2): 172-179.
20. Boggi U, Del Chiaro M, Croce C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery, 2009, 146(5): 869-881.
21. Murakami Y, Satoi S, Motoi F, et al. Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg, 2015, 102(7): 837-846.
22. Wang J, Estrella JS, Peng L, et al. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage Ⅱ pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer, 2012, 118(15): 3801-3811.
23. Lapshyn H, Bronsert P, Bolm L, et al. Prognostic factors after pancreatoduodenectomy with en bloc portal venous resection for pancreatic cancer. Langenbecks Arch Surg, 2016, 401(1): 63-69.
24. Ramacciato G, Nigri G, Petrucciani N, et al. Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol, 2016, 23(6): 2028-2037.
25. Mierke F, Hempel S, Distler M, et al. Impact of portal vein involvement from pancreatic cancer on metastatic pattern after surgical resection. Ann Surg Oncol, 2016, 23(Suppl 5): 730-736.
26. Murakami Y, Uemura K, Sudo T, et al. Benefit of portal or superior mesenteric vein resection with adjuvant chemotherapy for patients with pancreatic head carcinoma. J Surg Oncol, 2013, 107(4): 414-421.
27. Turrini O, Ewald J, Barbier L, et al. Should the portal vein be routinely resected during pancreaticoduodenectomy for adenocarcinoma? Ann Surg, 2013, 257(4): 726-730.
28. Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer, 2010: 241.
29. Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2014, 155(6): 977-988.
30. Campbell F, Feakins R. Dataset for the histopathological reporting of carcinomas of the pancreas, ampulla of vater and common bile duct. London: Royal College of Pathologists, 2017: 17-18.
31. 柯能文, 刘续宝. 胰十二指肠切除术在胰头癌治疗中的应用与进展. 中国普外基础与临床杂志, 2019, 26(4): 385-388.
32. Murakami Y, Uemura K, Sudo T, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg, 2008, 195(6): 757-762.
33. Murakami Y, Uemura K, Sudo T, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol, 2012, 106(2): 174-180.
34. Adham M, Jaeck D, Le Borgne J, et al. Long-term survival (5–20 years) after pancreatectomy for pancreatic ductal adenocarcinoma: a series of 30 patients collected from 3 institutions. Pancreas, 2008, 37(4): 352-357.
35. Bissolati M, Sandri MT, Burtulo G, et al. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer. Tumour Biol, 2015, 36(2): 991-996.
36. Kim J, Reber HA, Dry SM, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut, 2006, 55(11): 1598-1605.
37. Van den Broeck A, Sergeant G, Ectors N, et al. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol, 2009, 35(6): 600-604.
38. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg, 2004, 8(8): 935-949.
39. Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs. gemcitabine followed pancreatic cancer resection: a randomized controlled trial. JAMA, 2010, 304(10): 1073-1081.
40. Shi S, Yu X. Selecting chemotherapy for pancreatic cancer: far away or so close? Semin Oncol, 2019, 46(1): 39-47.
41. 奚士航, 王小明. 胰腺癌新辅助化疗的应用现状及进展. 中国普外基础与临床杂志, 2020, 27(2): 226-231.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical significance of portal or superior mesenteric vein invasion during pancreaticoduodenectomy for pancreatic adenocarcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content