title: Prognostic factors after pancreatoduodenectomy with en bloc portal venous resection for pancreatic cancer.
abstract: OBJECTIVE
  Pancreatoduodenectomy (PD) with superior mesenteric/portal venous resection (PVR) for pancreatic ductal adenocarcinoma (PDAC) is performed routinely in case of tumor adhesion to the superior mesenteric or portal vein. True histopathological portal vein invasion (PVI) is found in a subgroup of patients. Even though this procedure has become routine in most centers for pancreatic surgery, data on prognostic factors in this situation is limited. The aim of this study was to identify prognostic factors after PD with PVR for PDAC.
  
  
  METHODS
  Retrospective analysis was performed on the basis of a prospectively maintained database, and paraffin-embedded formalin-fixed tissue slides stained for hematoxylin-eosin were re-evaluated by two independent pathologists. Statistical analysis was conducted using MedCalc software.
  
  
  RESULTS
  From 2001 to 2012, 86 cases of PD with PVR for PDAC with long-term follow-up and sufficient tissue for re-assessment were identified. Histopathological re-review disclosed PVI in 39 resection specimens and adhesion without infiltration in 47. Overall median survival in all patients was 22 months. Patients with PVI versus no PVI showed comparable baseline demographic and standard histopathological parameters; however, PVI was associated with microscopic hemangiosis (p = 0.001) and positive margin status (p = 0.001). Median survival in patients with PVI was 14 months versus 25 months in patients without PVI (p = 0.042). Only lymph node ratio and PVI were independent predictors of survival after resection.
  
  
  CONCLUSIONS
  The only independent factors influencing overall survival after PD with PVR for PDAC were lymph node ratio and PVI. PVI might indicate aggressive tumor biology, but the available data remains controversial.
authors.affiliation: Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.|Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Hryhoriy
authors.initials: H
authors.lastname: Lapshyn
authors.affiliation: Institute of Surgical Pathology, University Medical Center Freiburg, Freiburg, Germany.|Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
authors.affiliation: Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Louisa
authors.initials: L
authors.lastname: Bolm
authors.affiliation: Institute of Surgical Pathology, University Medical Center Freiburg, Freiburg, Germany.|Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Freiburg, Germany.|German Cancer Consortium (DKTK) and Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.affiliation: Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany. ulrich.hopt@uniklinik-freiburg.de.|Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Freiburg, Germany. ulrich.hopt@uniklinik-freiburg.de.
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.|Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Clinic for General and Visceral Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.|Comprehensive Cancer Center Freiburg, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Uwe A
authors.initials: UA
authors.lastname: Wittel
authors.affiliation: Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.affiliation: Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Ulrich F
authors.initials: UF
authors.lastname: Wellner
authors.affiliation: Clinic for Surgery, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bausch
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate
keywords: Median survival; Pancreatic ductal adenocarcinoma; Pancreatoduodenectomy; Portal venous resection; Portal venous tumor infiltration