Perioperative and Long-Term Outcome after Standard Pancreaticoduodenectomy, Additional Portal Vein and Multivisceral Resection for Pancreatic Head Cancer

Introduction The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in...

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Published in:Journal of gastrointestinal surgery 2015-03, Vol.19 (3), p.438-444
Main Authors: Kulemann, Birte, Hoeppner, Jens, Wittel, Uwe, Glatz, Torben, Keck, Tobias, Wellner, Ulrich F., Bronsert, Peter, Sick, Olivia, Hopt, Ulrich T., Makowiec, Frank, Riediger, Hartwig
Format: Article
Language:English
Subjects:
2014 SSAT Poster Presentation
Adenocarcinoma - secondary
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Blood Transfusion
Blood transfusions
Cancer therapies
Chemotherapy
Female
Gastroenterology
Hospital Mortality
Humans
Lymphatic Metastasis
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Mortality
Neoplasm, Residual
Pancreatic cancer
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - methods
Portal Vein - surgery
Retrospective Studies
Risk Factors
Surgery
Survival analysis
Survival Rate
Time Factors
Treatment Outcome
Veins & arteries
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Summary:Introduction The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in PDAC patients. Methods Clinicopathologic, perioperative, and survival data of patients undergoing pancreatic head resection (PHR) for PDAC 1994–2014 were reviewed from a prospective database. Results Three hundred fifty nine patients had PHR for PDAC: 208 (58 %) underwent SPR, 131 (36 %) additional PV, and 20 (6 %) MV. The postoperative complication rate in MV (65 %) was slightly higher than in PV (56 %) or SPR (50 %; p  = 0.32). MV patients had higher in-hospital mortality (10 %) than SPR (3.8 %) and PV (1.5 %) patients ( p  = 0.12). Nodal status was comparable, whereas more patients in PV and MV had final R0 resection ( p  = 0.02). Five-year survival was 7 % after MV versus 17 % in patients without MV ( p  = 0.07). Multivariate survival analysis identified resection margin, nodal disease, blood transfusions, and MV are set as independent risk factors for overall survival. Conclusion Multivisceral pancreatic head resections for PDAC are associated with increased perioperative morbidity and mortality, without improving oncologic outcome. Portal vein resection can be performed safely to reach R0 resection and its survival benefits.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-014-2725-8