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)
Year: 2024
Type: article
Study design: Observational Study
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.
Source: Annals of Surgical Oncology
Authors: Thomas F. Stoop, Simone Augustinus, Bergthor Björnsson, Bobby Tingstedt, Bodil Andersson, Christopher L. Wolfgang, Jens Werner, Karin Johansen, Martijn W. J. Stommel, Matthew H. G. Katz, Michael Ghadimi, Michael G. House, Poya Ghorbani, I. Quintus Molenaar, Roeland F. de Wilde, J. Sven D. Mieog, Tobias Keck, Ulrich F. Wellner, Waldemar Uhl, Marc G. Besselink, Henry A. Pitt, Marco Del Chiaro, for the Global Audits on Pancreatic Surgery Group (GAPASURG), Tara M. Mackay, Salvador Rodriguez Franco, Susan Dierenvan Dieren
Institutions: Karolinska University Hospital, Amsterdam UMC Location University of Amsterdam, Karolinska Institutet, Cancer Center Amsterdam, University of Colorado Anschutz, Linköping University, Lund University, Skåne University Hospital, NYU Langone Health, New York University, LMU Klinikum, Ludwig-Maximilians-Universität München, Radboud University Medical Center, The University of Texas MD Anderson Cancer Center, Universitätsmedizin Göttingen, University of Göttingen, Indiana University School of Medicine, Utrecht University, University Medical Center Utrecht, St. Antonius Ziekenhuis, Erasmus MC, Erasmus MC Cancer Institute, Leiden University Medical Center, University Hospital Schleswig-Holstein, St. Josef-Hospital, Ruhr University Bochum, Rutgers Cancer Institute
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W4401459675