Portal vein resection during pancreaticoduodenectomy for pancreatic neuroendocrine tumors. An international multicenter comparative study

胰十二指肠切除术 医学 围手术期 胰腺癌 外科 临床终点 神经内分泌肿瘤 肠系膜上静脉 回顾性队列研究 倾向得分匹配 存活率 胃肠病学 内科学 门静脉 癌症 切除术 随机对照试验
作者
Giuseppe Fusai,Domenico Tamburrino,Stefano Partelli,Panagis M. Lykoudis,Peter Pipan,Francesca Di Salvo,Nassiba Beghdadi,Safi Dokmak,Dominik Wiese,Luca Landoni,Chiara Nessi,Olivier R. Busch,Niccolò Napoli,Jin Young Jang,Wooil Kwon,Marco Del Chiaro,Chiara Maria Scandavini,Mahmoud Abuawwad,Thomas Armstrong,M. Abu Hilal,Peter J. Allen,Ammar A. Javed,Magnus Kjellman,Alain Sauvanet,Detlef K. Bartsch,Claudio Bassi,Els J. M. Nieveen van Dijkum,Marc G. Besselink,Ugo Boggi,Sun Whe Kim,Jin He,Christofer L. Wolfgang,Massimo Falconi
出处
期刊:Surgery [Elsevier]
卷期号:169 (5): 1093-1101 被引量:10
标识
DOI:10.1016/j.surg.2020.11.015
摘要

Background The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasms patients is lacking. Methods This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. Results Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). Conclusion This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.
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