Venous Resection During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma—A Multicentre Propensity Score Matching Analysis of the Recurrence After Whipple’s (RAW) Study

<b>Background</b>: 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. <b>Methods</b>: In total, 435 PDAC patients with either R0 status (<i>n</i> = 322) or R1 status within the superior mesenteric vein groove (<i>n</i> = 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). <b>Results</b>: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, <i>p</i> = 0.032) and R1 resection rates (17.9% vs. 42%, <i>p</i> < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (<i>p</i> < 0.001 for sleeve and <i>p</i> = 0.034 for segmental resection), pT3 (<i>p</i> = 0.007), and pN1 stage (<i>p</i> = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), <i>p</i> = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, <i>p</i> = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, <i>p</i> = 0.928) or DFS (R0: 18 m, R1: 17 m, <i>p</i> = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (<i>p</i> = 0.034). <b>Conclusions</b>: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.

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Publication Details

Journal
Cancers
Published
2025-04-04
DOI
https://doi.org/10.3390/cancers17071223
Citations
2
Primary Topic
Pancreatic and Hepatic Oncology Research
Type
article
Field-Weighted Citation Impact
2.09

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article

Venous Resection During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma—A Multicentre Propensity Score Matching Analysis of the Recurrence After Whipple’s (RAW) Study

Zaed Hamady, Thomas Russell, Sarah C. Thomasset, Bilal Al-Sarireh et al.
2 citations
Cancers
Pancreatic and Hepatic Oncology Research
2.09
article

Venous Resection During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma—A Multicentre Propensity Score Matching Analysis of the Recurrence After Whipple’s (RAW) Study

Zaed Hamady, Thomas Russell, Sarah C. Thomasset, Bilal Al-Sarireh, Elizabeth Pando, Parthi Srinivasan, Keith Roberts, Ruben Bellotti, Michael A. Silva, Somaiah Aroori, Pavlos Lykoudis, Gabriele Marangoni, Fabio Ausania, Alberto Porcu, Stefan Schneeberger, Florian Ponholzer, Alejandro Serrablo, Pierfrancesco Lapolla, Hassaan Bari, Brian R Davidson, Benno Cardini, Dhanny Gomez, Vasileios Mavroeidis, Peter Labib, Ricky H. Bhogal, Andrew M. Smith, Nassir Alhaboob, Ambareen Kausar, Adam E. Frampton, Duncan Spalding, Daniel Croagh, Andrea Mingoli, Ismael Dominguez, Nehal Shah, Rohan Thakkar
article en
2 citations

Abstract

<b>Background</b>: 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. <b>Methods</b>: In total, 435 PDAC patients with either R0 status (<i>n</i> = 322) or R1 status within the superior mesenteric vein groove (<i>n</i> = 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). <b>Results</b>: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, <i>p</i> = 0.032) and R1 resection rates (17.9% vs. 42%, <i>p</i> < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (<i>p</i> < 0.001 for sleeve and <i>p</i> = 0.034 for segmental resection), pT3 (<i>p</i> = 0.007), and pN1 stage (<i>p</i> = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), <i>p</i> = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, <i>p</i> = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, <i>p</i> = 0.928) or DFS (R0: 18 m, R1: 17 m, <i>p</i> = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (<i>p</i> = 0.034). <b>Conclusions</b>: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.

CancersVol. 17(7)
Swansea Bay University Health Board (GB), University Hospitals Birmingham NHS Foundation Trust (GB), NHS Lothian (GB), Royal Marsden NHS Foundation Trust (GB), Nottingham University Hospitals NHS Trust (GB), Innsbruck Medical University (AT), Imperial College Healthcare NHS Trust (GB), Royal Free London NHS Foundation Trust (GB), Universität Innsbruck (AT), University of Hull (GB), Leeds Teaching Hospitals NHS Trust (GB), Policlinico Umberto I (IT), University Hospitals Bristol NHS Foundation Trust (GB), Monash Medical Centre (AU), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), University Hospital Coventry (GB), University Hospital Southampton NHS Foundation Trust (GB), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX), Sheffield Teaching Hospitals NHS Foundation Trust (GB), Azienda Ospedaliero Universitaria di Sassari (IT), King's College Hospital NHS Foundation Trust (GB), Hospital Universitario Miguel Servet (ES), Hospital Clínic de Barcelona (ES), Vall d'Hebron Hospital Universitari (ES), Shaukat Khanum Memorial Cancer Hospital and Research Center (PK), Royal Surrey NHS Foundation Trust (GB), Oxford University Hospitals NHS Trust (GB), University Hospitals Plymouth NHS Trust (GB), University Hospitals Bristol and Weston NHS Foundation Trust (GB), East Lancashire Hospitals NHS Trust (GB)
Medizinische Universität Innsbruck, Universität Innsbruck
Openalex Percentile: Top 13%
Pancreatic and Hepatic Oncology Research
2.09
DOIOpen Access PDFOpenAlex
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