Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Autor: Hans Jörg Mischinger, Rainer Langeder, Gottfried Sodeck, Peter Kornprat, Katharina Marsoner, Dora Csengeri
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Gastroenterology
Pancreaticoduodenectomy
Pancreatic ductal adenocarcinoma
03 medical and health sciences
Long-term survival
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
medicine
Prevalence
Humans
Portal vein resection
Hospital Mortality
Survival rate
Aged
Retrospective Studies
Medicine(all)
business.industry
Proportional hazards model
Portal Vein
Retrospective cohort study
General Medicine
Perioperative
Middle Aged
medicine.disease
Combined Modality Therapy
Surgery
Log-rank test
Pancreatic Neoplasms
Survival Rate
Treatment Outcome
030220 oncology & carcinogenesis
Austria
Cohort
Adenocarcinoma
030211 gastroenterology & hepatology
Female
Original Article
business
Vascular Surgical Procedures
Carcinoma
Pancreatic Ductal
Perioperative outcome
Zdroj: Wiener Klinische Wochenschrift
ISSN: 1613-7671
Popis: Summary Introduction Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma. Patients and methods Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short- and long-term survival were assessed via multivariate logistic and Cox regression. Results Baseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66, 95 % CI 1.24–91.30). Follow-up was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10–3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31–3.58) were independent predictors. Conclusion Despite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.
Databáze: OpenAIRE
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