title: Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis.
abstract: BACKGROUND
  Pancreaticoduodenectomy combined with portal-superior mesenteric vein synchronous resection for cancer remains a hot debate topic. The present study used meta-analytical technique to provide update information and an evidence-based evaluation on both the perioperative benefit and long-term survival.
  
  
  METHODS
  A meta-analysis was performed to evaluate studies comparing venous resection (VR) versus without venous resection (WVR) groups. 22 retrospective studies including 2890 patients were eligible for an analysis of perioperative morbidity, mortality, and long-term survival. Furthermore, subgroup analysis was made according to histopathology and resection margin status respectively for the purpose of survival assessment.
  
  
  RESULTS
  There was no difference in perioperative morbidity, mortality and 1-year, 3-year survival between two groups, but showed differences in median tumor size (P < 0.001), R0 resection rate (P < 0.001), lymph node metastasis (P = 0.03), pancreatic fistula (P = 0.01), and 5-year survival (P = 0.03). In subgroup analysis, patients in venous resection group received R0 resection had a significantly better survival comparing with who received R1 resection both at 2-year (P < 0.001) and 5-year (P = 0.00002). In histopathology subgroup, patients in venous resection groups who had true tumor infiltration had a significantly bad survival comparing with whom only with inflammation pathology.
  
  
  CONCLUSIONS
  Pancreaticoduodenectomy combined with venous resection can achieve equal perioperative morbidity and mortality as standard resection. However, in order to obtain an optimal survival outcome, surgeons should make an R0 resection as far as possible, especially in cases need synchronous venous resection.
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
authors.forename: X Z
authors.initials: XZ
authors.lastname: Yu
authors.affiliation: Pancreatic Disease Institute, Fudan University, Shanghai 200040, PR China.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
authors.forename: D L
authors.initials: DL
authors.lastname: Fu
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Di
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
authors.forename: F
authors.initials: F
authors.lastname: Yang
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
authors.forename: S J
authors.initials: SJ
authors.lastname: Hao
authors.affiliation: Pancreatic Surgery Department, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, PR China. Electronic address: galleyking@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Jin
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D008207:Lymphatic Metastasis; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D059035:Perioperative Period; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Meta-analysis; PV/SMV resection; Pancreaticoduodenectomy; R0 resection