Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Ann Surg. 2023 Jun 1;277(6):e1291-e1298. doi: 10.1097/SLA.0000000000005444. Epub 2022 Jul 6.
To evaluate the outcomes of pancreatic cancer [pancreatic ductal adenocarcinoma (PDAC)] surgery with concomitant portal vein resection (PVR), focusing on the PVR type according to the International Study Group of Pancreatic Surgery (ISGPS).
Surgery offers the only chance for cure in PDAC. PVR is often performed for borderline or locally advanced tumors.
Consecutive patients with PDAC operated between January 2006 and January 2018 were included. Clinicopathologic characteristics and outcomes were analyzed and tested for survival prediction.
Of 2265 PDAC resections, 1571 (69.4%) were standard resections and 694 (30.6%) were resections with PVR, including 149 (21.5%) tangential resections with venorrhaphy (ISGPS type 1), 21 (3.0%) resections with patch reconstruction (type 2), 491 (70.7%) end-to-end anastomoses (type 3), and 33 (4.8%) resections with graft interposition (type 4). The 90-day mortality rate was 2.6% after standard resection and 6.3% after resection with PVR ( P <0.0001). Postoperative portal vein thrombosis and pancreas-specific surgical complications most frequently occurred after PVR with graft interposition (21.2% and 48.5%, respectively). In multivariable analysis, age 70 years and above, ASA stages 3/4, increased preoperative serum carbohydrate antigen 19-9, neoadjuvant treatment, total pancreatectomy, PVR, higher UICC stage, and R+ resections were significant negative prognostic factors for overall survival. Radical R0 (>1 mm) resection resulted in 23.3 months of median survival.
This is the largest single-center, comparative cohort study of PVR in PDAC surgery, showing that postoperative morbidity correlates with the reconstruction type. When radical resection is achieved, thrombosis risk is outweighed by beneficial overall survival times of nearly 2 years.
评估伴有门静脉切除（PVR）的胰腺癌[胰腺导管腺癌（PDAC）]手术的结果，重点关注根据国际胰腺外科研究组（ISGPS）的 PVR 类型。
手术是 PDAC 唯一的治愈机会。PVR 通常用于边界或局部进展期肿瘤。
纳入 2006 年 1 月至 2018 年 1 月期间连续接受 PDAC 手术的患者。分析并测试了临床病理特征和结果，以预测生存。
在 2265 例 PDAC 切除术中，1571 例（69.4%）为标准切除术，694 例（30.6%）为伴有 PVR 的切除术，包括 149 例（21.5%）切线缝合术（ISGPS 1 型）、21 例（3.0%）修补重建术（2 型）、491 例（70.7%）端端吻合术（3 型）和 33 例（4.8%）移植间置术（4 型）。标准切除术后 90 天死亡率为 2.6%，PVR 切除术后为 6.3%（P<0.0001）。术后门静脉血栓形成和胰腺特异性手术并发症最常发生在伴有移植间置术的 PVR 后（分别为 21.2%和 48.5%）。多变量分析显示，年龄 70 岁及以上、ASA 分级 3/4、术前血清碳水化合物抗原 19-9 升高、新辅助治疗、全胰切除术、PVR、更高的 UICC 分期和 R+切除术是总生存的显著负预后因素。根治性 R0（>1mm）切除可获得 23.3 个月的中位生存时间。
这是最大的单中心、比较性胰腺导管腺癌手术 PVR 队列研究，表明术后发病率与重建类型相关。当实现根治性切除时，血栓形成的风险会被近 2 年的有益总生存时间所抵消。
