title: Vein involvement during pancreaticoduodenectomy: is there a need for redefinition of "borderline resectable disease"?
abstract: BACKGROUND
  Current National Comprehensive Cancer Network guidelines recommend neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma to increase the likelihood of achieving R0 resection. A consensus has not been reached on the degree of venous involvement that constitutes borderline resectability. This study compares the outcome of patients who underwent pancreaticoduodenectomy with or without vein resection without neoadjuvant therapy.
  
  
  METHODS
  A multi-institutional database of patients who underwent pancreaticoduodenectomy was reviewed. Patients who required vein resection due to gross vein involvement by tumor were compared to those without evidence of vein involvement.
  
  
  RESULTS
  Of 492 patients undergoing pancreaticoduodenectomy, 70 (14 %) had vein resection and 422 (86 %) did not. There was no difference in R0 resection (66 vs. 75 %, p = NS). On multivariate analysis, vein involvement was not predictive of disease-free or overall survival.
  
  
  CONCLUSIONS
  This is the largest modern series examining patients with or without isolated vein involvement by pancreas cancer, none of whom received neoadjuvant therapy. Oncological outcome was not different between the two groups. These data suggest that up-front surgical resection is an appropriate option and call into question the inclusion of isolated vein involvement in the definition of "borderline resectable disease."
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Kaitlyn J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Emily
authors.initials: E
authors.lastname: Winslow
authors.forename: David
authors.initials: D
authors.lastname: Kooby
authors.forename: Neha L
authors.initials: NL
authors.lastname: Lad
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Parikh
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Syed
authors.initials: S
authors.lastname: Ahmad
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.forename: Nipun B
authors.initials: NB
authors.lastname: Merchant
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D019043:Vascular Neoplasms / Q000473:pathology* / Q000601:surgery*