Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Marsoner, K; Langeder, R; Csengeri, D; Sodeck, G; Mischinger, HJ; Kornprat, P.
Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?
Wien Klin Wochenschr. 2016; 128(15-16):566-572
Doi: 10.1007/s00508-016-1024-7
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- Führende Autor*innen der Med Uni Graz
- Kornprat Peter
- Marsoner Katharina
- Co-Autor*innen der Med Uni Graz
- Csengeri Dora
- Mischinger Hans-Jörg
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- Abstract:
- 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. 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. 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. 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged -
- Austria - epidemiology
- Carcinoma, Pancreatic Ductal - mortality
- Carcinoma, Pancreatic Ductal - surgery
- Combined Modality Therapy - methods
- Combined Modality Therapy - mortality
- Female -
- Hospital Mortality -
- Humans -
- Male -
- Middle Aged -
- Pancreatic Neoplasms - mortality
- Pancreatic Neoplasms - surgery
- Pancreaticoduodenectomy - methods
- Pancreaticoduodenectomy - mortality
- Portal Vein - surgery
- Postoperative Complications - mortality
- Postoperative Complications - prevention & control
- Prevalence -
- Retrospective Studies -
- Risk Factors -
- Survival Rate -
- Treatment Outcome -
- Vascular Surgical Procedures - methods
- Vascular Surgical Procedures - mortality
- Find related publications in this database (Keywords)
- Pancreatic ductal adenocarcinoma
- Pancreaticoduodenectomy
- Portal vein resection
- Perioperative outcome
- Long-term survival