title: Adverse tumor biology associated with mesenterico-portal vein resection influences survival in patients with pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.
  
  
  METHODS
  Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD-VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.
  
  
  RESULTS
  Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD-VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD-VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD-VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.
  
  
  CONCLUSIONS
  PD with VR has similar morbidity but worse OS compared with a PD-VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, St Leonards, NSW, Australia, fwang1881@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.forename: M
authors.initials: M
authors.lastname: Neale
authors.forename: V
authors.initials: V
authors.lastname: Puttaswamy
authors.forename: S
authors.initials: S
authors.lastname: Gananadha
authors.forename: N
authors.initials: N
authors.lastname: Pavlakis
authors.forename: S
authors.initials: S
authors.lastname: Clarke
authors.forename: T J
authors.initials: TJ
authors.lastname: Hugh
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001808:Blood Vessels / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010525:Peripheral Nerves / Q000473:pathology; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden