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
Date
2025-04-04
Type
Article
Subject
Gastroenterology, Oncology. Pathology., Surgery
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.
Journal / Source Title
Cancers
DOI
10.3390/cancers17071223
PMID
40227808
Publisher
MDPI
Publisher’s URL
https://www.mdpi.com/journal/cancers