Outcomes of adjuvant chemoradiation after pancreaticoduodenectomy with mesenterico-portal vein resection for adenocarcinoma of the pancreas.
OBJECTIVE
Surgery followed by chemotherapy and radiation (CRT) offers patients with pancreatic adenocarcinoma a chance for extended survival. In some patients, however, resection is difficult because of vascular involvement by the carcinoma, necessitating resection and grafting of the mesenterico-portal vessels. The purpose of this study was to compare outcomes between pancreaticoduodenectomy (PD) with and without mesenterico-portal vein resection (VR) in patients receiving adjuvant CRT for pancreatic adenocarcinoma.


METHODS
Between 1993 and 2005, 160 patients underwent PD with 5-FU-based adjuvant CRT followed by maintenance chemotherapy at the Johns Hopkins Hospital; 20 (12.5%) of the 160 underwent VR. Clinical outcomes, including median survival, overall survival, and complication rates were assessed for both groups.


RESULTS
Patients who underwent VR had significantly longer operative times (p = 0.009), greater intraoperative blood loss (p = 0.01), and longer postoperative lengths of stay (p = 0.03). However, postoperative morbidity, median survival, and overall survival rates were similar between the two groups. Most patients (70%) from both groups were able to complete CRT, and a subgroup analysis demonstrated no appreciable differences in terms of complications. None of the VR patients who received adjuvant CRT developed veno-oclusive disease or graft failure/leakage.


CONCLUSIONS
In a cohort of patients treated with adjuvant 5-FU-based CRT at the Johns Hopkins Hospital, having a VR at the time of PD resulted in similar complication rates and survival. These data support the feasibility and safety of adjuvant CRT in patients undergoing VR at the time of PD.
Hristov
Boris
B
Department of Radiation Oncology and Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD, USA.
Reddy
Sushanth
S
Lin
Steven H
SH
Cameron
John L
JL
Pawlik
Timothy M
TM
Hruban
Ralph H
RH
Swartz
Michael J
MJ
Edil
Barish H
BH
Kemp
Clinton
C
Wolfgang
Christopher L
CL
Herman
Joseph M
JM
D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D013997:Time Factors
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil