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Surgical Outcome After Distal Pancreatectomy With and Without Portomesenteric Venous Resection in Patients with Pancreatic Adenocarcinoma: A Transatlantic Evaluation of Patients in North America, Germany, Sweden, and The Netherlands (GAPASURG).
Stoop, Thomas F; Augustinus, Simone; Björnsson, Bergthor; Tingstedt, Bobby; Andersson, Bodil; Wolfgang, Christopher L; Werner, Jens; Johansen, Karin; Stommel, Martijn W J; Katz, Matthew H G; Ghadimi, Michael; House, Michael G; Ghorbani, Poya; Molenaar, I Quintus; de Wilde, Roeland F; Mieog, J Sven D; Keck, Tobias; Wellner, Ulrich F; Uhl, Waldemar; Besselink, Marc G; Pitt, Henry A; Del Chiaro, Marco.
Afiliación
  • Stoop TF; Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. t.f.stoop@amsterdamumc.nl.
  • Augustinus S; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. t.f.stoop@amsterdamumc.nl.
  • Björnsson B; Cancer Center Amsterdam, Amsterdam, The Netherlands. t.f.stoop@amsterdamumc.nl.
  • Tingstedt B; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden. t.f.stoop@amsterdamumc.nl.
  • Andersson B; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands.
  • Wolfgang CL; Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • Werner J; Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
  • Johansen K; Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
  • Stommel MWJ; Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
  • Katz MHG; Division of Surgical Oncology, Department of Surgery, New York University Medical Center, New York City, NY, USA.
  • Ghadimi M; Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany.
  • House MG; Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
  • Ghorbani P; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Molenaar IQ; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • de Wilde RF; Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany.
  • Mieog JSD; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
  • Keck T; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
  • Wellner UF; Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht/St. Antonius Ziekenhuis Nieuwegein, Utrecht & Nieuwegein, The Netherlands.
  • Uhl W; Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
  • Besselink MG; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
  • Pitt HA; DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany.
  • Del Chiaro M; DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany.
Ann Surg Oncol ; 31(12): 8327-8339, 2024 Nov.
Article en En | MEDLINE | ID: mdl-39120839
ABSTRACT

BACKGROUND:

Pancreatic adenocarcinoma located in the pancreatic body might require a portomesenteric venous resection (PVR), but data regarding surgical risks after distal pancreatectomy (DP) with PVR are sparse. Insight into additional surgical risks of DP-PVR could support preoperative counseling and intraoperative decision making. This study aimed to provide insight into the surgical outcome of DP-PVR, including its potential risk elevation over standard DP.

METHODS:

We conducted a retrospective, multicenter study including all patients with pancreatic adenocarcinoma who underwent DP ± PVR (2018-2020), registered in four audits for pancreatic surgery from North America, Germany, Sweden, and The Netherlands. Patients who underwent concomitant arterial and/or multivisceral resection(s) were excluded. Predictors for in-hospital/30-day major morbidity and mortality were investigated by logistic regression, correcting for each audit.

RESULTS:

Overall, 2924 patients after DP were included, of whom 241 patients (8.2%) underwent DP-PVR. Rates of major morbidity (24% vs. 18%; p = 0.024) and post-pancreatectomy hemorrhage grade B/C (10% vs. 3%; p = 0.041) were higher after DP-PVR compared with standard DP. Mortality after DP-PVR and standard DP did not differ significantly (2% vs. 1%; p = 0.542). Predictors for major morbidity were PVR (odds ratio [OR] 1.500, 95% confidence interval [CI] 1.086-2.071) and conversion from minimally invasive to open surgery (OR 1.420, 95% CI 1.032-1.970). Predictors for mortality were higher age (OR 1.087, 95% CI 1.045-1.132), chronic obstructive pulmonary disease (OR 4.167, 95% CI 1.852-9.374), and conversion from minimally invasive to open surgery (OR 2.919, 95% CI 1.197-7.118), whereas concomitant PVR was not associated with mortality.

CONCLUSIONS:

PVR during DP for pancreatic adenocarcinoma in the pancreatic body is associated with increased morbidity, but can be performed safely in terms of mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Neoplasias Pancreáticas / Vena Porta / Complicaciones Posoperatorias / Adenocarcinoma / Venas Mesentéricas Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Neoplasias Pancreáticas / Vena Porta / Complicaciones Posoperatorias / Adenocarcinoma / Venas Mesentéricas Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos