Rangelova Elena B, Ghorbani Poya, Valente Roberto, Tanaka Kimitaka, Halimi Asif, Arnelo Urban, Segersvärd Ralf, Sparrelid Ernesto, Del Chiaro Marco
Department of Surgery, Section for Upper Abdominal Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Division of Surgery and Oncology, Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2025 Jan 23:109629. doi: 10.1016/j.ejso.2025.109629.
Pancreatectomy with venous resection (PVR) is nowadays considered standard. However, there is still concern about increased postoperative morbidity and impaired long-term outcome depending on the type of venous resection and reconstruction. The aim was to investigate the predictors of morbidity and long-term survival in patients undergoing PVR in a high-volume center.
All consecutive patients undergoing PVR at a single center between January 2008 and January 2019 were retrieved from a prospectively maintained database. Factors associated with postoperative complications and long-term survival were analyzed.
Of 290 patients with isolated PVRs, 188 (65 %) were performed for pancreatic ductal adenocarcinoma (PDAC). Surgical complications developed in 56 % of patients (n = 163), and 11 % (n = 36) had severe complications (Clavien-Dindo>3a). The 90-day mortality was 4.1 %. Venous thrombosis occurred in 4.8 % (n = 14), resulting in one mortality (0.3 %). No technical factors were predictive for the development of severe complications. Longer vein segments >3 cm could be resected with similar short- and long-term outcome as shorter segments. The survival of patients undergoing PVR for resectable, borderline and locally advanced PDAC was similar (median of 18, 14, and 23 months, p = 0.7). On multivariate analysis, elevated CA19-9>200 U/mL and ASA score≥3 were independent predictors of survival (p = 0.02), but not resectability at diagnosis nor type of venous reconstruction.
The type of venous resection/reconstruction does not influence outcome and should be tailored according to patients' and tumors' characteristics during PVR. The long-term survival after PVR for PDAC is influenced by tumor-and patient-related characteristics, and not technical vascular-resection associated factors.
如今，胰腺切除术联合静脉切除（PVR）被视为标准术式。然而，根据静脉切除和重建的类型，术后发病率增加和长期预后受损仍令人担忧。本研究旨在调查在一个高容量中心接受PVR患者的发病预测因素和长期生存情况。
从一个前瞻性维护的数据库中检索2008年1月至2019年1月在单一中心接受PVR的所有连续患者。分析与术后并发症和长期生存相关的因素。
在290例单纯PVR患者中，188例（65%）因胰腺导管腺癌（PDAC）接受手术。56%（n = 163）的患者发生手术并发症，11%（n = 36）出现严重并发症（Clavien-Dindo>3a）。90天死亡率为4.1%。静脉血栓形成发生率为4.8%（n = 14），导致1例死亡（0.3%）。没有技术因素可预测严重并发症的发生。与较短节段相比，切除长度>3 cm的较长静脉节段的短期和长期预后相似。接受PVR治疗可切除、临界和局部晚期PDAC患者的生存率相似（中位数分别为18、14和23个月，p = 0.7）。多因素分析显示，CA19-9>200 U/mL升高和ASA评分≥3是生存的独立预测因素（p = 0.02），但不是诊断时的可切除性或静脉重建类型。
静脉切除/重建的类型不影响预后，应在PVR期间根据患者和肿瘤的特征进行调整。PDAC患者PVR后的长期生存受肿瘤和患者相关特征的影响，而非技术血管切除相关因素。
