Detailed Abstract
[Poster Presentation 1 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP PP 1-S1] Clinical Outcomes of Preservation Versus Resection of Portal/superior Mesenteric Vein during Pancreaticoduodenectomy in the Pancreatic Cancer Patients with Response to Neoadjuvant Chemotherapy
Yoon Soo CHAE 1, Hye-Sol JUNG 1, Youngmin HAN 1, Won-Gun YUN 1, Young Jae CHO 1, Mirang LEE 1, Wooil KWON 1, Jin-Young JANG 1
1 Department of Surgery And Cancer Research Institute, College of Medicine,, Seoul National University Hospital, REPUBLIC OF KOREA
Background : Whether the portal/superior mesenteric vein (PV/SMV) should be resected during pancreaticoduodenectomy (PD) in the pancreatic cancer patients with response to neoadjuvant chemotherapy (NAC) is controversial.
Methods : 113 patients with resectable and borderline resectable pancreatic ductal adenocarcinoma with venous involvement who showed improvement in tumor-vessel relationship after NAC and underwent curative PD were included. Serial computed tomography (CT) images after surgery were evaluated. PV/SMV stenosis was defined as reduction of more than 50% in diameter compared with postoperative 1st CT image.
Results : Among the 113 patients, there were 60 (53.1%) male patients and the mean age was 61.26 ± 9.62 years. FOLFIRINOX and gemcitabine-based NAC was given in 94 (83.2%) and 19 (16.8%) patients, respectively. PV/SMV preservation (PVP) and PV/SMV resection (PVR) was performed in 68 (60.2%) and 45 patients (39.8%), respectively. There was no significant difference in R0 rate (92.6 vs 91.1%; P = 0.768), 5-year recurrence free survival (median 17.1 vs 15.7 months; P = 0.887) and overall survival (median 31 vs 27.1 months; P = 0.867) between PVP and PVR group. The PV/SMV stenosis within 3 months after surgery was more likely to develop in PVR group than PVP group (22.2% vs 1.5%; P < 0.001). PVP group had a significantly better 5-year PV/SMV stenosis free ratio compared to PVR group (median 18.7 vs 12.5 months; P = 0.014).
Conclusions : If successful dissection is possible and there is a high likelihood of achieving R0 resection after NAC, routine PVR may not be necessary in pancreatic head cancer patients with venous involvement.
Methods : 113 patients with resectable and borderline resectable pancreatic ductal adenocarcinoma with venous involvement who showed improvement in tumor-vessel relationship after NAC and underwent curative PD were included. Serial computed tomography (CT) images after surgery were evaluated. PV/SMV stenosis was defined as reduction of more than 50% in diameter compared with postoperative 1st CT image.
Results : Among the 113 patients, there were 60 (53.1%) male patients and the mean age was 61.26 ± 9.62 years. FOLFIRINOX and gemcitabine-based NAC was given in 94 (83.2%) and 19 (16.8%) patients, respectively. PV/SMV preservation (PVP) and PV/SMV resection (PVR) was performed in 68 (60.2%) and 45 patients (39.8%), respectively. There was no significant difference in R0 rate (92.6 vs 91.1%; P = 0.768), 5-year recurrence free survival (median 17.1 vs 15.7 months; P = 0.887) and overall survival (median 31 vs 27.1 months; P = 0.867) between PVP and PVR group. The PV/SMV stenosis within 3 months after surgery was more likely to develop in PVR group than PVP group (22.2% vs 1.5%; P < 0.001). PVP group had a significantly better 5-year PV/SMV stenosis free ratio compared to PVR group (median 18.7 vs 12.5 months; P = 0.014).
Conclusions : If successful dissection is possible and there is a high likelihood of achieving R0 resection after NAC, routine PVR may not be necessary in pancreatic head cancer patients with venous involvement.
SESSION
Poster Presentation 1
Zone A 3/21/2024 2:50 PM - 3:30 PM