Vein involvement during pancreaticoduodenectomy: is there a need for redefinition of "borderline resectable disease"?

Autor: Kelly KJ; Department of Surgery, University of Wisconsin, Madison, WI, USA., Winslow E, Kooby D, Lad NL, Parikh AA, Scoggins CR, Ahmad S, Martin RC, Maithel SK, Kim HJ, Merchant NB, Cho CS, Weber SM
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2013 Jul; Vol. 17 (7), pp. 1209-17; discussion 1217. Date of Electronic Publication: 2013 Apr 26.
DOI: 10.1007/s11605-013-2178-5
Abstrakt: Introduction: Current National Comprehensive Cancer Network guidelines recommend neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma to increase the likelihood of achieving R0 resection. A consensus has not been reached on the degree of venous involvement that constitutes borderline resectability. This study compares the outcome of patients who underwent pancreaticoduodenectomy with or without vein resection without neoadjuvant therapy.
Methods: A multi-institutional database of patients who underwent pancreaticoduodenectomy was reviewed. Patients who required vein resection due to gross vein involvement by tumor were compared to those without evidence of vein involvement.
Results: Of 492 patients undergoing pancreaticoduodenectomy, 70 (14 %) had vein resection and 422 (86 %) did not. There was no difference in R0 resection (66 vs. 75 %, p = NS). On multivariate analysis, vein involvement was not predictive of disease-free or overall survival.
Conclusion: This is the largest modern series examining patients with or without isolated vein involvement by pancreas cancer, none of whom received neoadjuvant therapy. Oncological outcome was not different between the two groups. These data suggest that up-front surgical resection is an appropriate option and call into question the inclusion of isolated vein involvement in the definition of "borderline resectable disease."
Databáze: MEDLINE
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