TY - JOUR
T1 - Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer
T2 - impact on short- and long-term outcomes in a nationwide cohort analysis
AU - Groen, Jesse
AU - Michiels, Nynke
AU - van Roessel, Stijn
AU - Besselink, Marc G.
AU - Bosscha, Koop
AU - Busch, Olivier R.
AU - van Dam, Ronald
AU - van Eijck, Casper H. J.
AU - Koerkamp, Bas Groot
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - Karsten, Tom M.
AU - Lips, Daan J.
AU - de Meijer, Vincent E.
AU - Molenaar, Isaac Q.
AU - Nieuwenhuijs, Vincent B.
AU - Roos, Daphne
AU - van Santvoort, Hjalmar C.
AU - Wijsman, Jan H.
AU - Wit, Fennie
AU - Zonderhuis, Babs M.
AU - de Vos-Geelen, Judith
AU - Wasser, Martin N.
AU - Bonsing, Bert A.
AU - Stommel, Martijn W. J.
AU - Mieog, J. Sven D.
N1 - Funding:
This study was supported by a Bas Mulder Award (UL2015-7665)
from the Alpe d’HuZes Foundation/Dutch Cancer Society
(J.S.D.M.).
Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85122843066&partnerID=8YFLogxK
U2 - 10.1093/bjs/znab345
DO - 10.1093/bjs/znab345
M3 - Article
C2 - 34791069
AN - SCOPUS:85122843066
SN - 0007-1323
VL - 109
SP - 96
EP - 104
JO - The British journal of surgery
JF - The British journal of surgery
IS - 1
ER -
