title: Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer.
abstract: BACKGROUND
  The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in PDAC patients.
  
  
  METHODS
  Clinicopathologic, perioperative, and survival data of patients undergoing pancreatic head resection (PHR) for PDAC 1994-2014 were reviewed from a prospective database.
  
  
  RESULTS
  Three hundred fifty nine patients had PHR for PDAC: 208 (58 %) underwent SPR, 131 (36 %) additional PV, and 20 (6 %) MV. The postoperative complication rate in MV (65 %) was slightly higher than in PV (56 %) or SPR (50 %; p = 0.32). MV patients had higher in-hospital mortality (10 %) than SPR (3.8 %) and PV (1.5 %) patients (p = 0.12). Nodal status was comparable, whereas more patients in PV and MV had final R0 resection (p = 0.02). Five-year survival was 7 % after MV versus 17 % in patients without MV (p = 0.07). Multivariate survival analysis identified resection margin, nodal disease, blood transfusions, and MV are set as independent risk factors for overall survival.
  
  
  CONCLUSIONS
  Multivisceral pancreatic head resections for PDAC are associated with increased perioperative morbidity and mortality, without improving oncologic outcome. Portal vein resection can be performed safely to reach R0 resection and its survival benefits.
authors.affiliation: Department of Surgery, University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany, birte.kulemann@gmail.com.
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.forename: Uwe
authors.initials: U
authors.lastname: Wittel
authors.forename: Torben
authors.initials: T
authors.lastname: Glatz
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.forename: Ulrich F
authors.initials: UF
authors.lastname: Wellner
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
authors.forename: Olivia
authors.initials: O
authors.lastname: Sick
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.forename: Hartwig
authors.initials: H
authors.lastname: Riediger
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome