title: Factors influencing outcome in patients undergoing portal vein resection for adenocarcinoma of the pancreas.
abstract: BACKGROUND
  Survival rates after surgery and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDA) remain low. Selected patients with portal/superior mesenteric vein (PV) involvement undergo PV resection at pancreaticoduodenectomy (PD). This study analyses outcomes for PD with/without PV resection in patients with PDA.
  
  
  METHODS
  A retrospective analysis of prospectively collected data on patients requiring PD for histologically proven adenocarcinoma between 1/1997 and 9/2009 identified 326 patients with PDA, with 51 requiring PD with PV resection. Patients were analyzed in two groups: PD + PV resection vs. PD alone. Multivariate analysis was used to identify predictive variables influencing survival and the Kaplan-Meier method to estimate patient survival.
  
  
  RESULTS
  Mean age for patients with PV resection was 66.4 (range 46-80) years, 47% were male. Both groups had similar patient demographics, perioperative and tumor characteristics. Postoperative morbidity was similar for patients with and without PV resection (27.5 vs. 28.4%). 30-day mortality was significantly higher in patients with PV resection (13.7%) vs. PD alone (5.1%). Overall survival however was similar in both groups (median PD alone 14.8 months vs. 14.5 months PD + PV). Multivariate analysis identified age, tumor grading, stay on the ICU and lack of chemotherapy as independent risk factors for reduced long-term survival.
  
  
  CONCLUSIONS
  In carefully selected patients, PV resection results in similar long-term survival compared to PD alone. In selected patients, PV infiltration may be considered a sign of anatomical proximity of the tumor, rather than only a sign of increased tumor aggressiveness.
authors: The Liver Unit, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham B152TH, United Kingdom.
authors: V M
authors: VM
authors: Banz
authors: D
authors: D
authors: Croagh
authors: C
authors: C
authors: Coldham
authors: P
authors: P
authors: Tanière
authors: J
authors: J
authors: Buckels
authors: J
authors: J
authors: Isaac
authors: D
authors: D
authors: Mayer
authors: P
authors: P
authors: Muiesan
authors: S
authors: S
authors: Bramhall
authors: D F
authors: DF
authors: Mirza
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003082:Colectomy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011237:Predictive Value of Tests; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013156:Splenectomy; D016896:Treatment Outcome