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Int. J. Surg., Feb 24 2025, | https://doi.org/10.1097/JS9.0000000000002307
Implications of portal vein/superior mesenteric vein involvement in pancreatic cancer: a comprehensive correlation from preoperative radiological assessment to resection, pathology, and long-term outcomes: a retrospective cohort study
Kim, Hyeong Seok MD, MSa; Chae, Hochang MD, MSa; Lim, Soo Yeun MDa,b; Jeong, HyeJeong MD, MSa,c; Yoon, So Jeong MD, PhDa; Shin, Sang Hyun MD, PhDa; Han, InWoong MD, PhDa; Heo, Jin Seok MD, PhDa; Kim, Hongbeom MD, PhDa
aDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
bDepartment of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
cDepartment of Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
Corresponding author: H. Kim
aDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
bDepartment of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
cDepartment of Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
Corresponding author: H. Kim
Abstract
Background: The incidence of portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy is increasing in clinical practice. This study investigated the clinical significance of preoperative PV/SMV assessment and intraoperative resection and their correlation with pathological results and long-term survival outcomes.
Methods: We analyzed 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 based on PV/SMV resection. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status.
Results: Total of 441 patients were analyzed; 175 had PV/SMV involvement on preoperative radiological assessments and 128 underwent PV/SMV resection. True pathological invasion was observed in 78 patients (60.9%), with 34.3% showing no invasion and negative margins. The positive predictive value for preoperative PV/SMV involvement was 61.7%, with a false-negative value of 28.9%. Overall survival of patients who underwent PV/SMV resection was worse than those who did not (2-year survival rate, 38.1% vs 54.9%, P < 0.001). Patients without PV/SMV resection with an rR1/R1 margin showed no decrease in survival compared to those with PV/SMV resection and R0 margins (54.9% vs 40.3%, P = 0.029). Prognostic factors included hypertension, PV/SMV resection, PV/SMV R2 margin, T stage, N stage, cell differentiation, adjuvant treatment, and recurrence.
Conclusion: PV/SMV resection could ensure R0 resection but may lead to unnecessary resection. Careful consideration is essential in determining the need for PV/SMV resection. Poor survival in such patients highlights the need for tailored treatments, including neoadjuvant therapy, for those who are expected to undergo PV/SMV resections.
Methods: We analyzed 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 based on PV/SMV resection. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status.
Results: Total of 441 patients were analyzed; 175 had PV/SMV involvement on preoperative radiological assessments and 128 underwent PV/SMV resection. True pathological invasion was observed in 78 patients (60.9%), with 34.3% showing no invasion and negative margins. The positive predictive value for preoperative PV/SMV involvement was 61.7%, with a false-negative value of 28.9%. Overall survival of patients who underwent PV/SMV resection was worse than those who did not (2-year survival rate, 38.1% vs 54.9%, P < 0.001). Patients without PV/SMV resection with an rR1/R1 margin showed no decrease in survival compared to those with PV/SMV resection and R0 margins (54.9% vs 40.3%, P = 0.029). Prognostic factors included hypertension, PV/SMV resection, PV/SMV R2 margin, T stage, N stage, cell differentiation, adjuvant treatment, and recurrence.
Conclusion: PV/SMV resection could ensure R0 resection but may lead to unnecessary resection. Careful consideration is essential in determining the need for PV/SMV resection. Poor survival in such patients highlights the need for tailored treatments, including neoadjuvant therapy, for those who are expected to undergo PV/SMV resections.
논문정보
- Research article
- 2025년 02월 (BRIC 등록일 2025-03-13)
- 국내 연구진
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