title: Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection.
abstract: The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection.
  
  
  
  Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P+) and pathohistological PV/SMV tumor infiltration (I+): P+I+, P+I-, and P-I-. Statistical analysis was performed using the R software package.
  
  
  
  The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P+I+), and were matched with 66 cases without PV/SMV infiltration (P-I-). The study revealed differences in overall median survival (11.9 [P+I+] vs. 16.1 [P+I-] vs. 20.1 [P-I-] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P+I+] vs. 45.8 % [P+I-] vs. 54.7 % [P-I-], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P+I+] vs. 10.9 months [P+I-] vs. 11.6 months [P-I-]). Initial liver metastases occurred in 33 % of the patients.
  
  
  
  True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Mierke
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hempel
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Daniela E
authors.initials: DE
authors.lastname: Aust
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. thilo.welsch@uniklinikum-dresden.de.
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000556:secondary* / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary*; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors