Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer

Autor: Groen, J.V., Michiels, N., Roessel, S. van, Besselink, M.G., Bosscha, K., Busch, O.R., Dam, R. van, Eijck, C.H.J. van, Koerkamp, B.G., Harst, E. van der, Hingh, I.H. de, Karsten, T.M., Lips, D.J., Meijer, V.E. de, Molenaar, I.Q., Nieuwenhuijs, V.B., Roos, D., Santvoort, H.C. van, Wijsman, J.H., Wit, F., Zonderhuis, B.M., Vos-Geelen, J. de, Wasser, M.N., Bonsing, B.A., Stommel, M.W.J., Mieog, J.S.D., Dutch Pancreatic Canc Grp
Přispěvatelé: Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Epidemiologie, Interne Geneeskunde, MUMC+: MA Medische Oncologie (9), Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and quality of life, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: British Journal of Surgery, 109(1), 96-104. OXFORD UNIV PRESS
British Journal of Surgery, 109(1), 96-104. Wiley
British Journal of Surgery, 109, 1, pp. 96-104
The British journal of surgery, 109(1), 96-104. John Wiley & Sons Ltd.
Groen, J V, Michiels, N, van Roessel, S, Besselink, M G, Bosscha, K, Busch, O R, van Dam, R, van Eijck, C H J, Koerkamp, B G, van der Harst, E, de Hingh, I H, Karsten, T M, Lips, D J, de Meijer, V E, Molenaar, I Q, Nieuwenhuijs, V B, Roos, D, van Santvoort, H C, Wijsman, J H, Wit, F, Zonderhuis, B M, de Vos-Geelen, J, Wasser, M N, Bonsing, B A, Stommel, M W J & Mieog, J S D 2022, ' Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer : Impact on short-And long-Term outcomes in a nationwide cohort analysis ', British Journal of Surgery, vol. 109, no. 1, pp. 96-104 . https://doi.org/10.1093/bjs/znab345
British Journal of Surgery, 109(1), 96-104. John Wiley and Sons Ltd
The British journal of surgery, 109(1), 96-104. John Wiley and Sons Ltd
British Journal of Surgery, 109, 96-104
ISSN: 1365-2168
0007-1323
DOI: 10.1093/bjs/znab345
Popis: Background Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival. Methods This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013-2017). Results A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012). Conclusion In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.Of 1311 patients who underwent pancreatoduodenectomy, 17 per cent underwent venous wedge resection and 10 per cent underwent venous segmental resection. Venous segmental, but not venous wedge, resection was associated with higher major morbidity rates (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to no venous resection. This nationwide study found worse short- and long-term outcomes in patients who had venous segmental resection. The results of this study urge the need for improving outcomes in patients who require venous segmental resection.
Databáze: OpenAIRE
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