Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome.
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Stoop Thomas F, Molnár Adrienne, Seelen Leonard W F, Sugawara Toshitaka, Scheepens Jacobien C M, Ali Mahsoem, Javed Ammar A, Halimi Asif, Oba Atsushi, Groot Koerkamp Bas, Andersson Bodil, Williamsson Caroline, Wolfgang Christopher L, Ban Daisuke, Sparrelid Ernesto, Daams Freek, Kazemier Geert, van Santvoort Hjalmar C, Rompen Ingmar F, Molenaar I Quintus, Habib Joseph R, Beuk Lysanne P M, Geerdink Niek J, de Wilde Roeland F, Busch Olivier R, Swartling Oskar, Bereza-Carlson Paulina, Ghorbani Poya, Kruize Reeve L, Schulick Richard D, Rodriguez Franco Salvador, Miyata Tatsunori, Franklin Oskar, Inoue Yosuke, Besselink Marc G, Del Chiaro Marco, International Collaborative Group on Locally Advanced Pancreatic Cancer
Аннотация
BACKGROUND: Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability.
METHODS: An international retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180 degrees PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders.
RESULTS: Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95% CI, 17-32) after tangential and 23% (95% CI, 17-30) after segmental PVR ( P =0.98). After adjusting for confounders, PVR type was not associated with OS [HR=0.94 (95% CI, 0.69-1.30)], RFS [HR=0.94 (95% CI, 0.69-1.28)], and locoregional recurrence [OR=0.76 (95% CI, 0.40-1.46)].
CONCLUSIONS: In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180 degrees PMV involvement, the type of PVR (ie, tangential vs segmental) was not associated with differences in surgical and oncological outcome. This suggests that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.