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Redefinir el adenocarcinoma ductal pancreático resecable por adelantado: ¿debe importar el abutment de la vena?
Po Hong Tan1, Cornelius A Thiels2, Katherine Poruk3
11Department of Surgery, Mayo Clinic, Phoenix, AZ.
Journal of the National Comprehensive Cancer Network : JNCCN
|February 11, 2026
Resumen
El abuto de la vena portomesentérica en el cáncer de páncreas resecable empeora los resultados con la cirugía frontal. La terapia neoadyuvante mitiga esto, mejorando la supervivencia y las tasas de resección R0 para pacientes con adenocarcinoma ductal pancreático.
Área de la Ciencia:
- Oncología Quirúrgica Oncología Quirúrgica.
- Gastroenterología y Gastroenterología.
- La investigación clínica es la investigación clínica.
Sus antecedentes:
- El adenocarcinoma ductal pancreático resecable frontal (PDAC) está definido por las directrices de la NCCN como tener una abutment de la vena portomesentérica (PMV) de ≤180°.
- La importancia clínica del abutment de PMV en esta cohorte de pacientes no ha sido explorada previamente.
Objetivo del estudio:
- Investigar el impacto del abutment de PMV en las tasas de supervivencia y resección en pacientes con PDAC resecable inicial.
- Para comparar los resultados entre la cirugía inicial y la terapia neoadyuvante (NAT) en pacientes con y sin abutment de PMV.
Principales métodos:
- Un estudio multiinstitucional incluyó a 1.446 pacientes sometidos a pancreatoduodenectomía por PDAC resecable por adelantado (2002-2023).
- Se comparó a los pacientes con abutment de PMV ≤180° con los que no tenían abutment.
- Se analizó la supervivencia global (OS), estratificada por cirugía inicial frente a NAT.
Principales resultados:
- De 1.446 pacientes, 521 (36,0%) tenían abutment de VMP. La mediana de la OS fue similar entre los grupos (28,8 vs 31,2 meses; P=.17).
- Los pacientes con cirugía frontal con abutment de PMV tenían peor OS (19.2 vs 27.6 meses; P<.05) y menores tasas de resección de R0 (63.1% vs 87.2%; P<.05).
- Los pacientes con NAT con abutment de PMV no mostraron diferencias en las tasas de resección de R0 (91.4% vs 94.0%; P=.27) u OS (42.5 vs 51.6 meses; P=.48).
Conclusiones:
- El abutment de PMV está asociado con una OS peor en el PDAC resecable frontal cuando se trata con cirugía frontal.
- La terapia neoadyuvante en pacientes con PMV abutment mitiga las diferencias de supervivencia y mejora las tasas de resección R0.
- Los criterios actuales de NCCN pueden necesitar una redefinición, lo que sugiere que NAT beneficia a los pacientes con abutment de PMV para obtener resultados óptimos.
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