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Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer : An International Multicenter Cohort Study on Surgical and Oncological Outcome

Stoop, Thomas F. ; Molnár, Adrienne ; Seelen, Leonard W.F. ; Sugawara, Toshitaka ; Scheepens, Jacobien C.M. ; Ali, Mahsoem ; Javed, Ammar A. ; Halimi, Asif ; Oba, Atsushi and Groot Koerkamp, Bas , et al. (2025) In Annals of Surgery
Abstract

Objective: To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement. Summary Background Data: Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability. Methods: International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on... (More)

Objective: To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement. Summary Background Data: Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability. Methods: International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders. Results: Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]). Conclusions: In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
pancreatic cancer, Pancreatoduodenectomy, segmental, survival, tangential, venous resection
in
Annals of Surgery
article number
6638
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:39846439
  • scopus:85217120808
ISSN
0003-4932
DOI
10.1097/SLA.0000000000006638
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s).
id
977d205f-36cb-4b0e-89b1-4a545be9ae83
date added to LUP
2025-04-01 22:22:05
date last changed
2025-07-09 06:14:33
@article{977d205f-36cb-4b0e-89b1-4a545be9ae83,
  abstract     = {{<p>Objective: To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement. Summary Background Data: Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability. Methods: International retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders. Results: Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]). Conclusions: In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.</p>}},
  author       = {{Stoop, Thomas F. and Molnár, Adrienne and Seelen, Leonard W.F. and Sugawara, Toshitaka and Scheepens, Jacobien C.M. and Ali, Mahsoem and Javed, Ammar A. and Halimi, Asif and Oba, Atsushi and Groot Koerkamp, Bas and Andersson, Bodil and Williamsson, Caroline and Wolfgang, Christopher L. and Ban, Daisuke and Sparrelid, Ernesto and Daams, Freek and Kazemier, Geert and Van Santvoort, Hjalmar C. and Rompen, Ingmar F. and Molenaar, I. Quintus and Habib, Joseph R. and Beuk, Lysanne P.M. and Geerdink, Niek J. and De Wilde, Roeland F. and Busch, Olivier R. and Swartling, Oskar and Bereza-Carlson, Paulina and Ghorbani, Poya and Kruize, Reeve L. and Schulick, Richard D. and Franco, Salvador Rodriguez and Miyata, Tatsunori and Franklin, Oskar and Inoue, Yosuke and Besselink, Marc G. and Del Chiaro, Marco}},
  issn         = {{0003-4932}},
  keywords     = {{pancreatic cancer; Pancreatoduodenectomy; segmental; survival; tangential; venous resection}},
  language     = {{eng}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Annals of Surgery}},
  title        = {{Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer : An International Multicenter Cohort Study on Surgical and Oncological Outcome}},
  url          = {{http://dx.doi.org/10.1097/SLA.0000000000006638}},
  doi          = {{10.1097/SLA.0000000000006638}},
  year         = {{2025}},
}