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Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer

BACKGROUND: Whether the portal/superior mesenteric vein (PV) should be resected during pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) based on preoperative CT or intraoperative findings is controversial. METHODS: This was a retrospective study with data of patients who had undergo...

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Autores principales: Kishi, Y., Nara, S., Esaki, M., Hiraoka, N., Shimada, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551409/
https://www.ncbi.nlm.nih.gov/pubmed/31183449
http://dx.doi.org/10.1002/bjs5.50130
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author Kishi, Y.
Nara, S.
Esaki, M.
Hiraoka, N.
Shimada, K.
author_facet Kishi, Y.
Nara, S.
Esaki, M.
Hiraoka, N.
Shimada, K.
author_sort Kishi, Y.
collection PubMed
description BACKGROUND: Whether the portal/superior mesenteric vein (PV) should be resected during pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) based on preoperative CT or intraoperative findings is controversial. METHODS: This was a retrospective study with data of patients who had undergone pancreatoduodenectomy for PDAC between 2002 and 2016 in a tertiary referral centre. Based on the extent of contact between the PV and tumour on CT, patients were categorized into: group 1, no contact; group 2, contact 180° or less; group 3, contact greater than 180°. Extent of pathological PV invasion (pPV) (no invasion, pv0; invasion to tunica adventitia, pv1; invasion to media, pv2; invasion to intima, pv3) was compared with patient survival. To assess the feasibility of performing PV resection (PVR) based on intraoperative findings, the prognosis of patients in groups 1 and 2 with pv0 and no PVR (PVR(−)pv0) was compared with that of patients who had PVR (PVR(+)pv0), selected using propensity score matching. RESULTS: Groups 1, 2 and 3 comprised 230, 232 and 38 patients respectively, and PVR was performed in 10·9, 73·3 and 95 per cent of them (P < 0·001). Extent of pPV differed significantly (P < 0·001). The positive predictive value of radiological tumour contact with PV in predicting positive pPV was 42·6 per cent. In 64 patients with PVR(−)pv0 and 64 matched patients with PVR(+)pv0, the R0 resection rate (66 versus 73 per cent respectively; P = 0·337) and survival (median 32·4 versus 32·1 months; P = 0·780) were not significantly different. CONCLUSION: PVR is needed only when the tumour is in clear contact with the PV and cannot be detached during surgery.
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spelling pubmed-65514092019-06-10 Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer Kishi, Y. Nara, S. Esaki, M. Hiraoka, N. Shimada, K. BJS Open Original Articles BACKGROUND: Whether the portal/superior mesenteric vein (PV) should be resected during pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) based on preoperative CT or intraoperative findings is controversial. METHODS: This was a retrospective study with data of patients who had undergone pancreatoduodenectomy for PDAC between 2002 and 2016 in a tertiary referral centre. Based on the extent of contact between the PV and tumour on CT, patients were categorized into: group 1, no contact; group 2, contact 180° or less; group 3, contact greater than 180°. Extent of pathological PV invasion (pPV) (no invasion, pv0; invasion to tunica adventitia, pv1; invasion to media, pv2; invasion to intima, pv3) was compared with patient survival. To assess the feasibility of performing PV resection (PVR) based on intraoperative findings, the prognosis of patients in groups 1 and 2 with pv0 and no PVR (PVR(−)pv0) was compared with that of patients who had PVR (PVR(+)pv0), selected using propensity score matching. RESULTS: Groups 1, 2 and 3 comprised 230, 232 and 38 patients respectively, and PVR was performed in 10·9, 73·3 and 95 per cent of them (P < 0·001). Extent of pPV differed significantly (P < 0·001). The positive predictive value of radiological tumour contact with PV in predicting positive pPV was 42·6 per cent. In 64 patients with PVR(−)pv0 and 64 matched patients with PVR(+)pv0, the R0 resection rate (66 versus 73 per cent respectively; P = 0·337) and survival (median 32·4 versus 32·1 months; P = 0·780) were not significantly different. CONCLUSION: PVR is needed only when the tumour is in clear contact with the PV and cannot be detached during surgery. John Wiley & Sons, Ltd 2019-01-24 /pmc/articles/PMC6551409/ /pubmed/31183449 http://dx.doi.org/10.1002/bjs5.50130 Text en © 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Kishi, Y.
Nara, S.
Esaki, M.
Hiraoka, N.
Shimada, K.
Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title_full Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title_fullStr Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title_full_unstemmed Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title_short Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
title_sort feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6551409/
https://www.ncbi.nlm.nih.gov/pubmed/31183449
http://dx.doi.org/10.1002/bjs5.50130
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