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Implications of portal vein/superior mesenteric vein involvement in pancreatic cancer: A comprehensive correlation from preoperative radiological assessment to resection, pathology, and long-term outcomes. A retrospective cohort study

  • 0Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
International Journal of Surgery (london, England) +

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February 25, 2025

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February 25, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy is increasing. Careful assessment is crucial as resection may not always be necessary and can negatively impact survival outcomes.

Area Of Science

  • Gastroenterology and Hepatology
  • Surgical Oncology
  • Vascular Surgery

Background

  • Increasing incidence of portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy.
  • Need to investigate the clinical significance of preoperative PV/SMV assessment and intraoperative resection.
  • Correlation with pathological results and long-term survival outcomes.

Purpose Of The Study

  • To evaluate the clinical significance of preoperative PV/SMV assessment.
  • To analyze the impact of intraoperative PV/SMV resection on pathological results.
  • To determine the correlation between PV/SMV resection and long-term survival.

Main Methods

  • Analysis of 443 patients undergoing pancreatoduodenectomy from 2012-2017.
  • Subgroup analyses based on preoperative PV/SMV involvement, resection, and margin status.
  • Correlation of radiological assessment with pathological findings and survival data.

Main Results

  • 128 patients underwent PV/SMV resection; 78 (60.9%) had true pathological invasion.
  • Preoperative assessment had a positive predictive value of 61.7% and a false-negative value of 28.9%.
  • PV/SMV resection was associated with worse overall survival (38.1% vs 54.9%, P < 0.001).

Conclusions

  • PV/SMV resection can achieve R0 resection but may lead to unnecessary procedures.
  • Careful patient selection is essential to avoid unnecessary PV/SMV resections.
  • Tailored treatments, including neoadjuvant therapy, are needed for patients requiring PV/SMV resection due to poor survival outcomes.

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