Outcome after pancreaticoduodenectomy for T3 adenocarcinoma: A multivariable analysis from the UK Vascular Resection for Pancreatic Cancer Study Group.
BACKGROUND
Most resectable pancreatic cancers are classified as T3, including those involving the porto-mesenteric vein. Survival and perioperative morbidity for venous resection have been found to be comparable to standard resection. We investigate factors associated with short and long term outcomes in pancreaticoduodenectomy with (PDVR) and without (PD) venous resection exclusively for T3 adenocarcinoma of the head of the pancreas.


METHODS
This is a UK multicenter retrospective cohort study assessing outcomes in patients undergoing PD and PDVR. All consecutive patients with T3 only adenocarcinoma of the head of the pancreas undergoing surgery between December 1998 and June 2011 were included. Multivariable logistic and proportional hazards regression analyses were performed to determine the association between the surgical groups and in-hospital mortality (IHM) and overall survival (OS).


RESULTS
1070 patients were included of whom 840 (78.5%) had PD and 230 (21.5%) had PDVR. Factors independently associated with IHM were a high creatinine (aHR 1.14, p = 0.02), post-operative bleeding (aHR 2.86, p = 0.04) and a re-laparotomy (aHR 8.42, p = 0.0001). For OS, multivariable analyses identified R1 resection margin status (aHR 1.22, p = 0.01), N1 nodal status (aHR 1.92, p = 0.0001), perineural invasion (aHR 1.37, p = 0.002), tumour size >20mm (aHR 0.63, p = 0.0001) and a relaparotomy (aHR 1.84, p = 0.0001) to be independently associated with overall mortality.


CONCLUSIONS
This study on T3 adenocarcinoma of the head of the pancreas suggests that IHM is strongly associated with perioperative complications whilst OS is affected by histological parameters. Detailed pre-operative disease evaluation and advances in oncological treatment have the potential to improve OS.
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK. Electronic address: Hassan.elberm@nhs.net.
H
H
Elberm
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
R
R
Ravikumar
Research Department of Infection and Population Health, UCL, Royal Free Campus, UK.
C
C
Sabin
Department of HPB Surgery, Southampton General Hospital, Southampton, UK.
M
M
Abu Hilal
Department of HPB Surgery, Southampton General Hospital, Southampton, UK.
A
A
Al-Hilli
Department of HPB Surgery, Plymouth Hospitals, Plymouth, UK.
S
S
Aroori
Department of HPB Surgery, Royal London Hospital, London, UK.
G
G
Bond-Smith
Liver Unit, University Hospital Birmingham, Birmingham, UK.
S
S
Bramhall
Liver Unit, University Hospital Birmingham, Birmingham, UK.
C
C
Coldham
Department of HPB, Nottingham University Hospitals, UK.
J
J
Hammond
Department of HPB Surgery, Royal London Hospital, London, UK.
R
R
Hutchins
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
C
C
Imber
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
G
G
Preziosi
Department of HPB and Transplantation, Freeman Hospital, Newcastle, UK.
A
A
Saleh
Department of HPB Surgery, Churchill Hospital, Oxford, UK.
M
M
Silva
Department of HPB, Nottingham University Hospitals, UK.
J
J
Simpson
Department of HPB Surgery, Churchill Hospital, Oxford, UK.
G
G
Spoletini
Department of HPB Surgery, Plymouth Hospitals, Plymouth, UK.
D
D
Stell
Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK.
J
J
Terrace
Department of HPB and Transplantation, Freeman Hospital, Newcastle, UK.
S
S
White
Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK.
S
S
Wigmore
Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK.
G
G
Fusai
D000230:Adenocarcinoma / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
Adenocarcinoma; Multivariable analysis; Outcomes; Pancreas cancer; Pancreaticoduodenectomy; T3 pancreatic cancer