Venous resection for pancreatic cancer, a safe and feasible option? A systematic review and meta-analysis

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2022-09, Vol.22 (6), p.803-809
• Main Authors: Zwart, E.S., Yilmaz, B.S., Halimi, A., Ahola, R., Kurlinkus, B., Laukkarinen, J., Ceyhan, G.O.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Cancer therapies; Carcinoma; Collaboration; Hemorrhage; Humans; Infiltration; Librarians; Medical prognosis; Mesenteric vein; Mesenteric Veins - pathology; Meta-analysis; Metastases; Morbidity; Mortality; Pancreatectomy; Pancreatectomy - methods; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - pathology; Pancreaticoduodenectomy; Patients; Portal vein; Portal Vein - surgery; Retrospective Studies; Statistical analysis; Surgery; Survival; Systematic review; Tumors; Veins & arteries
• ISSN: 1424-3903; 1424-3911; 1424-3911
• DOI: 10.1016/j.pan.2022.05.001

In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.