Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Impact of postoperative superior mesenteric/portal vein stenosis on survival outcomes among pancreatic head ductal adenocarcinoma patients undergoing pancreaticoduodenectomy with combined venous resection following neoadjuvant chemoradiotherapy: a single-center retrospective study.
СтатьяНазвание и аннотация: Перевод в очереди
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Kaluba Benson, Kuriyama Naohisa, Nagata Motonori, Segi Yuki, Komatsubara Haruna, Gyoten Kazuyuki, Ito Takahiro, Hayasaki Aoi, Fujii Takehiro, Iizawa Yusuke, Murata Yasuhiro, Tanemura Akihiro, Kishiwada Masashi, Mizuno Shugo
Аннотация
BACKGROUND: The study aimed to assess the impact of postoperative superior mesenteric/portal vein (SMV/PV) stenosis on survival outcomes in patients with pancreatic head ductal adenocarcinoma undergoing pancreaticoduodenectomy (PD) with combined venous resection following neoadjuvant chemoradiotherapy.
METHODS: From April 2007 to August 2022, 226 patients were enrolled; of these, 185 underwent PD with SMV/PV resection. Of these, 53.5% (99/185) developed stenosis; 23 (23.2%) had early (≤ 30 days) stenosis, while 76 (76.8%) had late (> 30 days) stenosis onset. Prognostic predictors of stenosis and survival outcomes were also identified.
RESULTS: Patients with stenosis had a greater tumor-SMV/PV interface, more advanced tumors, greater intraoperative blood loss, longer operation times, and inferior survival outcomes than those without. Median survival times for overall survival (OS) were 28.7 months (no stenosis) vs 23.1 months (with stenosis) (P =.034). Similarly, based on onset, OS was 12.9 months (early) vs 26.7 months (late) (P =.005). Predictors of stenosis included T-category, tumor-SMV/PV interface, SMV/PV resection length, and Clavien-Dindo (CD) grade ≥ III complications. In the entire cohort, stenosis was an independent adverse prognostic factor for OS (hazard ratio [HR] 2.29; P <.001). Among patients with stenosis, early-onset stenosis was further associated with poor OS (HR 2.285; P =.003).
CONCLUSION: Postoperative SMV/PV stenosis was an independent predictor of poor survival after PD, especially when its onset was early. Its predictors included advanced tumor status, tumor-SMV/PV interface, SMV/PV resection length, and CD grade ≥ III complications, emphasizing the need for careful surgery and close follow-up.
METHODS: From April 2007 to August 2022, 226 patients were enrolled; of these, 185 underwent PD with SMV/PV resection. Of these, 53.5% (99/185) developed stenosis; 23 (23.2%) had early (≤ 30 days) stenosis, while 76 (76.8%) had late (> 30 days) stenosis onset. Prognostic predictors of stenosis and survival outcomes were also identified.
RESULTS: Patients with stenosis had a greater tumor-SMV/PV interface, more advanced tumors, greater intraoperative blood loss, longer operation times, and inferior survival outcomes than those without. Median survival times for overall survival (OS) were 28.7 months (no stenosis) vs 23.1 months (with stenosis) (P =.034). Similarly, based on onset, OS was 12.9 months (early) vs 26.7 months (late) (P =.005). Predictors of stenosis included T-category, tumor-SMV/PV interface, SMV/PV resection length, and Clavien-Dindo (CD) grade ≥ III complications. In the entire cohort, stenosis was an independent adverse prognostic factor for OS (hazard ratio [HR] 2.29; P <.001). Among patients with stenosis, early-onset stenosis was further associated with poor OS (HR 2.285; P =.003).
CONCLUSION: Postoperative SMV/PV stenosis was an independent predictor of poor survival after PD, especially when its onset was early. Its predictors included advanced tumor status, tumor-SMV/PV interface, SMV/PV resection length, and CD grade ≥ III complications, emphasizing the need for careful surgery and close follow-up.