TY - JOUR
T1 - Portal vein resection during pancreaticoduodenectomy for pancreatic neuroendocrine tumors. An international multicenter comparative study
AU - Fusai, Giuseppe K.
AU - Tamburrino, Domenico
AU - Partelli, Stefano
AU - Lykoudis, Panagis
AU - Pipan, Peter
AU - di Salvo, Francesca
AU - Beghdadi, Nassiba
AU - Dokmak, Safi
AU - Wiese, Dominik
AU - Landoni, Luca
AU - Nessi, Chiara
AU - Busch, O. R. C.
AU - Napoli, Niccolò
AU - Jang, Jin-Young
AU - Kwon, Wooil
AU - del Chiaro, Marco
AU - Scandavini, Chiara
AU - Abu-Awwad, Mahmoud
AU - Armstrong, Thomas
AU - Hilal, Mohamed Abu
AU - Allen, Peter J.
AU - Javed, Ammar
AU - Kjellman, Magnus
AU - Sauvanet, Alain
AU - Bartsch, Detlef K.
AU - Bassi, Claudio
AU - van Dijkum, E. J. M. Nieveen
AU - Besselink, M. G.
AU - Boggi, Ugo
AU - Kim, Sun-Whe
AU - He, Jin
AU - Wolfgang, Christofer L.
AU - Falconi, Massimo
N1 - Publisher Copyright: © 2020 Elsevier Inc.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background: The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasms patients is lacking. Methods: This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. Results: Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). Conclusion: This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.
AB - Background: The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasms patients is lacking. Methods: This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. Results: Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). Conclusion: This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85099512281&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33357999
UR - http://www.scopus.com/inward/record.url?scp=85099512281&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.surg.2020.11.015
DO - https://doi.org/10.1016/j.surg.2020.11.015
M3 - Article
C2 - 33357999
SN - 0039-6060
VL - 169
SP - 1093
EP - 1101
JO - Surgery (United States)
JF - Surgery (United States)
IS - 5
ER -