Comparative analysis between venous and standard pancreaticoduodenectomies for pancreatic head carcinoma
Literature review and institutional study
DOI:
https://doi.org/10.5281/zenodo.14862971Keywords:
pancreatic head carcinoma, pancreaticoduodenal resection, venous resectionAbstract
Introduction: Pancreatic cancer accounts for 90% of pancreatic malignancies, with approximately 15% of patients suitable for initial surgery. This fact necessitated the application of radical surgical approaches to achieve R0 resection and better survival.
Aim: The primary goal is to compare short- and long-term outcomes between pancreatoduodenectomies with and without venous resection in patients with pancreatic head carcinoma. A secondary aim is to compare predefined surgical and clinicopathological characteristics.
Methods: A monocentric, retrospective study of 645 patients operated for pancreatic head carcinoma. They are stratified into two groups – 121 patients (18.8%) with venous resection and reconstruction (VR) and 524 (81.2%) with standard pancreaticoduodenal resections (PDR). A value of p<0.05 is considered significant for the parametric and non-parametric statistical methods. Effect size (r) is examined to determine the clinical significance of overall survival, and multivariable regression analysis is used to determine the relationship between different risk factors.
Results: Overall survival was significant, 23.2 mo. in the VR group compared to 52.6 mo. in PDR (p<0.0001). However, a small effect size was found (r=0.42). 1-, 3-, and 5-year survival rates are significant. In VR, it is 59.8%, 20.2%, and 8%; in PDR, it is 78.5%, 37.3%, and 25.2%, respectively (p<0.001). When comparing the long-term results between PDR, VR, and palliative procedures (PP), significance is observed (p<0.0001). Higher mortality is found in VR, both in 30-day (p=0.005) and 90-day mortality (p=0.0002). However, no significance is found for 30-day mortality after 2014 (p=0.083). Significant complications (Clavien-Dindo>III) are similar (VR-16.8% vs. PDR-15.7%, p=0.77).
Conclusion: Compared with standard resections, venous have worse long-term with equivalent short-term results. However, they have a better survival rate than palliative procedures.
In experienced hands, venous resection and reconstruction is a safe and feasible intervention to achieve R0 when performed by an experienced team in high-volume centers.
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Copyright (c) 2023 Tsvetan Trichkov, K. Katsarov, E. Odiseeva, B. Ilcheva, A. Fakirova, K. Sapundzhiev, I. Popadiyn, Al. Katsarov, St. Dobrev, E. Gruda, E. Eyupov, St. Marvakov, I. Ivanov, V. Melnikov, V. Sirakov, V. Ivanov, R. Kostadinov, V. Mihaylov, N. Vladov (Author)
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