Venous resection during pancreatoduodenectomy for pancreatic ductal adenocarcinoma-A multicentre propensity score matching analysis of the Recurrence After Whipple's (RAW) study
Bellotti, Ruben Aroori, Somaiah Cardini, Benno Ponholzer, Florian Russell, Thomas B Labib, Peter L Schneeberger, Stefan Ausania, Fabio Pando, Elizabeth Robert, Keith J
Bellotti, Ruben
Aroori, Somaiah
Cardini, Benno
Ponholzer, Florian
Russell, Thomas B
Labib, Peter L
Schneeberger, Stefan
Ausania, Fabio
Pando, Elizabeth
Robert, Keith J
Abstract
Background: Pancreatoduodenectomy with venous resection (PDVR) may be performed to achieve tumour clearance in patients with a pancreatic ductal adenocarcinoma (PDAC) with venous involvement. This study aimed to evaluate the impact of PDVR on PDAC outcomes.
Methods: In total, 435 PDAC patients with either R0 status (n = 322) or R1 status within the superior mesenteric vein groove (n = 113) were extracted from the Recurrence After Whipple's (RAW) study dataset. PDVR patients were matched in a 1:2 ratio with standard PD patients. Comparisons were then made between the two groups (surgical radicality and survival).
Results: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, p = 0.032) and R1 resection rates (17.9% vs. 42%, p < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (p < 0.001 for sleeve and p = 0.034 for segmental resection), pT3 (p = 0.007), and pN1 stage (p = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), p = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, p = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, p = 0.928) or DFS (R0: 18 m, R1: 17 m, p = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (p = 0.034).
Conclusions: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.
MIDER Authors
Affiliations
Medical University of Innsbruck; University Hospitals Plymouth NHS Trust; Hospital Clinic de Barcelona; Hospital Universitari Vall D'Hebron; University Hospitals Birmingham NHS Foundation Trust; East Lancashire Hospitals NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; Royal Marsden NHS Foundation Trust; University Hospital Coventry and Warwickshire; NHS Lothian; Royal Surrey NHS Foundation Trust; Hull University Teaching Hospitals NHS Trust; Ibn Sina Specialized Hospital; Shaukat Khanum Memorial Cancer Hospital; Leeds Teaching Hospitals NHS Trust; Imperial College Healthcare NHS Trust; King's College Hospital NHS Foundation Trust; Royal Free London NHS Foundation Trust; Monash Medical Centre; Salvador Zubiran National Institute of Health Sciences and Nutrition; Newcastle upon Tyne Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust; Oxford University Hospitals NHS Foundation Trust; Policlinico Umberto I University Hospital Sapienza; Azienda Ospedaliero Universitaria di Sassari; Sheffield Teaching Hospital NHS Foundation Trust; University Hospital Southampton NHS Foundation Trust; Swansea Bay University Health Board; Hospital Universitario Miguel Servet
Date
2025-04-04
Type
Article
Citation
Bellotti R, Aroori S, Cardini B, Ponholzer F, Russell TB, Labib PL, Schneeberger S, Ausania F, Pando E, Roberts KJ, Kausar A, Mavroeidis VK, Marangoni G, Thomasset SC, Frampton AE, Lykoudis P, Alhaboob N, Bari H, Smith AM, Spalding D, Srinivasan P, Davidson BR, Bhogal RH, Croagh D, Dominguez I, Thakkar R, Gomez D, Silva MA, Lapolla P, Mingoli A, Porcu A, Shah NS, Hamady ZZR, Al-Sarrieh B, Serrablo A, Raw Study Collaborators, Maglione M. Venous Resection During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma-A Multicentre Propensity Score Matching Analysis of the Recurrence After Whipple's (RAW) Study. Cancers (Basel). 2025 Apr 4;17(7):1223. doi: 10.3390/cancers17071223.