Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 139] Implications of PV/SMV Involvement in PDAC: Preoperative Radiological Assessment, Resection to Pathological Correlation
Hyeong Seok KIM 1, Hochang CHAE 1, Soo Yeun LIM 1, HyeJeong JEONG 1, So Jeong YOON 1, Sang Hyun SHIN 1, In Woong HAN 1, Jin Seok HEO 1, Hongbeom KIM 1
1 Surgery, Samsung Medical Center, REPUBLIC OF KOREA
Background : The incidence of portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy for pancreatic cancer is increasing in clinical practice. This study investigated the clinical significance of preoperative PV/SMV assessment, intraoperative resection, and pathological correlation.
Methods : Total 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 were analyzed. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status.
Results : Total 441 patients analyzed, with 175 PV/SMV involvement in preoperative radiological assessments, and 124 undergoing PV/SMV resection. PV/SMV resection rate was higher in preoperative encasement/invasion compared to abutment and no involvement (72.2% vs 41.2% vs 9.0%, p<0.001). R0 resection rate was higher in PV/SMV resection than without resection (70.2% vs 46.7%, p=0.001); however, true invasion was 59.7% of resections, 34.7% showing no invasion with negative margins. Positive predictive value for preoperative PV/SMV involvement was 61.7%, with 29.3% false negative rate. PV/SMV resection group had poorer survival than without resection (median 19.0 vs 28.0 months, p<0.001). Survival varied significantly with margin status (R0 vs rR1 vs R1, 27.0 vs 26.0 vs 14.5 months, p=0.014). Prognostic factors included CA19-9 >150 U/mL, PV/SMV resection, R status, N stage, perineural invasion, and adjuvant treatment.
Conclusions : PV/SMV resection can ensure R0 resection but may lead to unnecessary resection. The risk of R1 resection, particularly rR1, increases when the PV/SMV is not resected in patients with preoperative involvement. Careful consideration is essential in determining PV/SMV resection. Poorer survival in PV/SMV resection patients highlights the need for tailored treatments, including neoadjuvant therapy, in anticipated PV/SMV resections.
Methods : Total 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 were analyzed. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status.
Results : Total 441 patients analyzed, with 175 PV/SMV involvement in preoperative radiological assessments, and 124 undergoing PV/SMV resection. PV/SMV resection rate was higher in preoperative encasement/invasion compared to abutment and no involvement (72.2% vs 41.2% vs 9.0%, p<0.001). R0 resection rate was higher in PV/SMV resection than without resection (70.2% vs 46.7%, p=0.001); however, true invasion was 59.7% of resections, 34.7% showing no invasion with negative margins. Positive predictive value for preoperative PV/SMV involvement was 61.7%, with 29.3% false negative rate. PV/SMV resection group had poorer survival than without resection (median 19.0 vs 28.0 months, p<0.001). Survival varied significantly with margin status (R0 vs rR1 vs R1, 27.0 vs 26.0 vs 14.5 months, p=0.014). Prognostic factors included CA19-9 >150 U/mL, PV/SMV resection, R status, N stage, perineural invasion, and adjuvant treatment.
Conclusions : PV/SMV resection can ensure R0 resection but may lead to unnecessary resection. The risk of R1 resection, particularly rR1, increases when the PV/SMV is not resected in patients with preoperative involvement. Careful consideration is essential in determining PV/SMV resection. Poorer survival in PV/SMV resection patients highlights the need for tailored treatments, including neoadjuvant therapy, in anticipated PV/SMV resections.
SESSION
E-poster
E-Session 03/21 ALL DAY