Bellotti Ruben, Aroori Somaiah, Cardini Benno, Ponholzer Florian, Russell Thomas B, Labib Peter L, Schneeberger Stefan, Ausania Fabio, Pando Elizabeth, Roberts Keith J, Kausar Ambareen, Mavroeidis Vasileios K, Marangoni Gabriele, Thomasset Sarah C, Frampton Adam E, Lykoudis Pavlos, Alhaboob Nassir, Bari Hassaan, Smith Andrew M, Spalding Duncan, Srinivasan Parthi, Davidson Brian R, Bhogal Ricky H, Croagh Daniel, Dominguez Ismael, Thakkar Rohan, Gomez Dhanny, Silva Michael A, Lapolla Pierfrancesco, Mingoli Andrea, Porcu Alberto, Shah Nehal S, Hamady Zaed Z R, Al-Sarrieh Bilal, Serrablo Alejandro, Maglione Manuel
Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK.
Cancers (Basel). 2025 Apr 4;17(7):1223. doi: 10.3390/cancers17071223.
: Pancreatoduodenectomy with venous resection (PDVR) may be performed to achieve tumour clearance in patients with a pancreatic ductal adenocarcinoma (PDAC) with venous involvement. This study aimed to evaluate the impact of PDVR on PDAC outcomes. : In total, 435 PDAC patients with either R0 status ( = 322) or R1 status within the superior mesenteric vein groove ( = 113) were extracted from the Recurrence After Whipple's (RAW) study dataset. PDVR patients were matched in a 1:2 ratio with standard PD patients. Comparisons were then made between the two groups (surgical radicality and survival). : A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, = 0.032) and R1 resection rates (17.9% vs. 42%, < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection ( < 0.001 for sleeve and = 0.034 for segmental resection), pT3 ( = 0.007), and pN1 stage ( = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, = 0.928) or DFS (R0: 18 m, R1: 17 m, = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group ( = 0.034). : Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.
对于伴有静脉侵犯的胰腺导管腺癌（PDAC）患者，可施行胰十二指肠切除术联合静脉切除（PDVR）以实现肿瘤清除。本研究旨在评估PDVR对PDAC患者预后的影响。：从惠普尔术后复发（RAW）研究数据集中提取了435例R0状态（n = 322）或肠系膜上静脉沟内R1状态（n = 113）的PDAC患者。PDVR患者与标准PD患者按1:2的比例进行匹配。然后对两组进行比较（手术根治性和生存率）。：共81例PDVR与162例PD相匹配。PDVR组的新辅助化疗率（5.7%对13.6%，P = 0.032）和R1切除率（17.9%对42%，P < 0.001）更高。R1切除的危险因素包括静脉切除（袖状切除P < 0.001，节段性切除P = 0.034）、pT3（P = 0.007）和pN1期（P = 0.045）。PDVR患者的中位总生存期（OS，21个月对30个月，P = 0.023）和无病生存期（DFS，17个月对24个月，P = 0.043）较低。在PDVR患者中，R状态对OS（R0：23个月，R1：21个月，P = 0.928）或DFS（R0：18个月，R1：17个月，P = 0.558）无影响。无论R状态如何，PDVR组的全身复发率更高（P = 0.034）。：不考虑R状态，PDVR组的总生存期较低且全身复发率较高。
