Multivisceral resection for pancreatic ductal adenocarcinoma with adjacent organ invasion: a propensity score-matched analysis.

BACKGROUND

Multivisceral resection (MVR) in pancreatic ductal adenocarcinoma (PDAC) involves en bloc resection of adjacent organs due to direct invasion. Despite its clinical significance, adjacent organ invasion is not included as a determinant in the American Joint Committee on Cancer (AJCC) staging or National Comprehensive Cancer Network resectability criteria. This study aimed to evaluate the safety and efficacy of MVR vs standard resection.

METHODS

This study analyzed 1222 patients who underwent surgery for PDAC at a tertiary institution between 2009 and 2019. Patients with stage IV disease, recurrent operations, incomplete data, or MVR performed for double primary malignancy were excluded. Propensity score matching (PSM) was performed at a 1:2 ratio, matching for operation type and AJCC T/N stages. Short- and long-term outcomes were compared between the 2 groups.

RESULTS

Before PSM, 42 MVR cases and 1099 standard resections demonstrated similar postoperative hospital stay lengths (11.4 vs 12.6 days, respectively; P =.094), major complications (23.8% vs 19.0%, respectively; P =.566), and clinically relevant postoperative pancreatic fistula (11.9% vs 6.6%, respectively; P =.310). However, compared with standard resections, MVR showed poorer long-term outcomes, including 2-year overall survival rate (2YSR; 49.9% vs 33.3%, respectively; P =.006), 2-year disease-free survival rate (2YDFSR; 25.9% vs 11.3%, respectively; P =.018), and 2-year local recurrence rate (2YLRR; 30.9% vs 41.3%, respectively; P =.319). After PSM, both groups maintained similar short-term outcomes and showed no statistical difference in 2YSR (P =.143), 2YDFSR (P =.279), and 2YLRR (P =.362).

CONCLUSION

MVR demonstrates comparable short- and long-term outcomes to standard resection and should be considered for selected patients with suspected organ invasion. Our findings reinforce current staging and resectability criteria and support surgical decision-making for PDAC.