title: Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate the operative risk and the prognostic implications of pancreatectomy plus resection and reconstruction of peripancreatic vessels (PPV) in patients with pancreatic adenocarcinoma.
  
  
  METHODS
  One hundred ten patients who underwent pancreatectomy with PPV resection and reconstruction (Study Group; SG) were retrospectively compared with 62 patients without distant metastasis who were palliated, (Control Group 1; CG-1), as well as 197 patients who underwent "conventional"pancreatectomy (Control Group 2; CG-2).
  
  
  RESULTS
  Postoperative morbidity and mortality were similar in SG (33% and 3%), in CG-1 (26% and 3%), and in CG-2 (40% and 6%) patients. Median survival time (MST) of SG patients (15 months) was longer than that of CG-1 patients (6 months; P < .0001) and similar to that of CG-2 patients (18 months). Patients undergoing isolated venous resection (n = 84) had the best outcome (MST: 15 months) ( P < .0001 vs CG-1 patients), while patients undergoing resection of multiple PPV (n = 14) had the worst outcome (MST: 8 months). PPV infiltration, histologically proven in 64 patients (65%), was associated with decreased MST only if the tunica intima was infiltrated (26%) (11 months; P < .001). Multivariate analysis showed that no adjuvant therapy, intimal invasion, and poorly differentiated histology were associated with a higher hazard of death by 2.2, 2.2, and 2.5-fold, respectively.
  
  
  CONCLUSIONS
  In properly selected patients, pancreatectomy plus resection and reconstruction of PPV was performed as safely as palliation or "conventional" pancreatectomy and was associated with better survival when compared to palliation.
authors.affiliation: Divisione di Chirurgia Generale e Trapianti nell'Uremico e nel Diabetico, Pisa, Italy. u.boggi@med.unipi.it
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Marco
authors.initials: M
authors.lastname: Del Chiaro
authors.forename: Chiara
authors.initials: C
authors.lastname: Croce
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Signori
authors.forename: Carlo
authors.initials: C
authors.lastname: Moretto
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mazzeo
authors.forename: Carla
authors.initials: C
authors.lastname: Cappelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Campani
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies