Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis

Jesse V. Groen, Nynke Michiels, Dutch Pancreatic Cancer Group, Stijn van Roessel, Marc G. Besselink, Koop Bosscha, Olivier R. Busch, Ronald van Dam, Casper H.J. van Eijck, Bas Groot Koerkamp, Erwin van der Harst, Ignace H. de Hingh, Tom M. Karsten, Daan J. Lips, Vincent E. de Meijer, Isaac Q. Molenaar, Vincent B. Nieuwenhuijs, Daphne Roos, Hjalmar C. van Santvoort, Jan H. WijsmanFennie Wit, Babs M. Zonderhuis, Judith de Vos-Geelen, Martin N. Wasser, Bert A. Bonsing, Martijn W.J. Stommel, J. Sven D. Mieog

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival. METHODS: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013-2017). RESULTS: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P  = 0.012). CONCLUSION: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.

Original languageEnglish
Pages (from-to)96-104
Number of pages9
JournalThe British journal of surgery
Volume109
Issue number1
DOIs
Publication statusE-pub ahead of print - 17 Nov 2021

Bibliographical note

Funding:
This study was supported by a Bas Mulder Award (UL2015-7665)
from the Alpe d’HuZes Foundation/Dutch Cancer Society
(J.S.D.M.).

Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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