title: Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?
abstract: BACKGROUND
  Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma.
  
  
  METHODS
  Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short- and long-term survival were assessed via multivariate logistic and Cox regression.
  
  
  RESULTS
  Baseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66, 95 % CI 1.24-91.30). Follow-up was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10-3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31-3.58) were independent predictors.
  
  
  CONCLUSIONS
  Despite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.
authors.affiliation: Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Marsoner
authors.affiliation: Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Langeder
authors.affiliation: Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Dora
authors.initials: D
authors.lastname: Csengeri
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.affiliation: Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Hans Jörg
authors.initials: HJ
authors.lastname: Mischinger
authors.affiliation: Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria. peter.kornprat@medunigraz.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Kornprat
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality*; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality
keywords: Long-term survival; Pancreatic ductal adenocarcinoma; Pancreaticoduodenectomy; Perioperative outcome; Portal vein resection