International Study Group of Pancreatic Surgery type 3 and 4 venous resections in patients with pancreatic adenocarcinoma:the Paoli-Calmettes Institute experience |
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| Affiliation: | 1. Department of Surgery, Institut Paoli-Calmettes, Marseille, France;2. Department of Oncology, Institut Paoli-Calmettes, Marseille, France;3. Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France;4. Department of Pathology, Institut Paoli-Calmettes, Marseille, France;5. Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France;6. Aix-Marseille University, Institut Paoli-Calmettes, Department of Surgery, CNRS, Inserm, CRCM, Marseille, France;1. Breast & Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia;2. The University of Sydney, Northern Clinical School, NSW, 2006, Australia;3. The Mater Hospital, North Sydney, NSW, 2060, Australia;4. Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;5. Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia;6. Chris O''Brien Lifehouse, Camperdown, NSW, 2050, Australia;7. Institute of Academic Surgery, Royal Prince Alfred Hospital, NSW, 2050, Australia;8. The University of Sydney, Professional Medical Education, Faculty of Medicine and Health, Camperdown, NSW, 2060, Australia;1. Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;3. Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China;2. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, China;3. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangdong, 510060, China;4. Department of Digestive Surgery, St. Mary''s Hospital, University of Perugia, Terni, 05100, Italy;1. Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia;2. Department of Vascular Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia;3. Discipline of Surgery, University of Sydney, Sydney, NSW, Australia;4. Macquarie University Hospital, Macquarie University, NSW, Australia;5. Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia;6. Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Australia;7. Department of Surgery, Auckland City Hospital, Auckland, New Zealand |
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| Abstract: | IntroductionA new neoadjuvant regimen, together with more aggressive surgeries, appears to have increased the resectability rate in patients with pancreatic ductal adenocarcinoma (PDAC). Our study aimed to evaluate the outcomes of patients who underwent venous resection (VR) during pancreatectomies for PDAC.Materials and methodsBetween 2005 and 2017, 130 patients underwent pancreatectomies with type 3 or 4 (i.e., segmental resection without or with graft interposition, respectively) VR for PDAC. Patients’ characteristics, surgical techniques, perioperative management, pathological findings, and outcomes were recorded and compared during 2 inclusion periods: the landmark year for the introduction of the FOLFIRINOX regimen and the hyperspecialization of our pancreatic-surgery team was 2010.ResultsPerformance of pancreatectomies with VR steadily increased through the 2 inclusion periods. In the overall series (n = 130), the median overall survival time and the 5-year survival proportion were 26.3 months and 21%, respectively. Upon multivariate analysis, ASA score 3 (P = 0.01) and R1 resection margins (P < 0.01) were found to be negative independent factors influencing survival. Patients who underwent upfront VR (n = 47) had survival rates similar to those of patients who received neoadjuvant treatment (n = 83). After 2010, more complex VR were performed; however, no difference was found between the 2 periods with respect to postoperative courses, pathologic findings, or survival after a matching process based on patients’ characteristics and tumor stages.ConclusionOver the last 2 decades, VR during pancreatectomy has been confirmed as a safe procedure despite the increase in technical complexity. Disappointingly, we did not observe any dramatic survival improvement. |
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| Keywords: | Segmental venous resection Pancreatic adenocarcinoma folfirinox Survival |
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