Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study.
BACKGROUND
Until recently, in the United Kingdom, borderline resectable pancreatic cancer with invasion into the portomesenteric veins often resulted in surgical bypass because of the presumed high risk for complications and the uncertainty of a survival benefit associated with a vascular resection. Portomesenteric vein resection has therefore remained controversial. We present the second largest published cohort of patients undergoing portal vein resection for borderline resectable (T3) adenocarcinoma of the head of the pancreas.


METHODS
This is a UK multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection (PDVR), standard pancreaticoduodenectomy (PD), and surgical bypass (SB). Nine high-volume UK centers contributed. All consecutive patients with T3 (stage IIA to III) adenocarcinoma of the head of the pancreas undergoing surgery between December 1998 and June 2011 were included. The primary outcomes measures are overall survival and in-hospital mortality. Secondary outcomes measure is operative morbidity.


RESULTS
One thousand five hundred and eighty-eight patients underwent surgery for borderline resectable pancreatic cancer; 840 PD, 230 PDVR, and 518 SB. Of 230 PDVR patients, 129 had primary closure (56%), 65 had end to end anastomosis (28%), and 36 had interposition grafts (16%). Both resection groups had greater complication rates than the bypass group, but with no difference between PD and PDVR. In-hospital mortality was similar across all 3 surgical groups. Median survival was 18 months for PD, 18.2 months for PDVR, and 8 months for SB (p = 0.0001).


CONCLUSIONS
This study, the second largest to date on borderline resectable pancreatic cancer, demonstrates no significant difference in perioperative mortality in the 3 groups and a similar overall survival between PD and PDVR; significantly better compared with SB.
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK. Electronic address: reena.ravikumar@nhs.net.
Reena
R
Ravikumar
Research Department of Infection and Population Health, UCL, Royal Free Campus, UK.
Caroline
C
Sabin
Department of HPB Surgery, Southampton General Hospital, Southampton, UK.
Mohammad
M
Abu Hilal
Liver Unit, University Hospital Birmingham, Birmingham, UK.
Simon
S
Bramhall
Department of HPB and Transplantation, Freeman Hospital, Newcastle, UK.
Steven
S
White
Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK.
Stephen
S
Wigmore
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
Charles J
CJ
Imber
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
Giuseppe
G
Fusai
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom