Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis

Jesse V Groen; Nynke Michiels; Stijn van Roessel; Marc G Besselink; Koop Bosscha; Olivier R Busch; Ronald van Dam; Casper H J van Eijck; Bas Groot Koerkamp; Erwin van der Harst; Ignace H de Hingh; Tom M Karsten; Daan J Lips; Vincent E de Meijer; Isaac Q Molenaar; Vincent B Nieuwenhuijs; Daphne Roos; Hjalmar C van Santvoort; Jan H Wijsman; Fennie Wit; Judith de Vos-Geelen; Martin N Wasser; Bert A Bonsing; Martijn W J Stommel; J Sven D Mieog; Dutch Pancreatic Cancer Group

doi:10.1093/bjs/znab345

Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis

Jesse V Groen^*, Nynke Michiels, Stijn van Roessel, Marc G Besselink, Koop Bosscha, Olivier R Busch, Ronald van Dam, Casper H J van Eijck, Bas Groot Koerkamp, Erwin van der Harst, Ignace H de Hingh, Tom M Karsten, Daan J Lips, Vincent E de Meijer, Isaac Q Molenaar, Vincent B Nieuwenhuijs, Daphne Roos, Hjalmar C van Santvoort, Jan H Wijsman, Fennie WitJudith de Vos-Geelen, Martin N Wasser, Bert A Bonsing, Martijn W J Stommel, J Sven D Mieog, Dutch Pancreatic Cancer Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival.

Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013–2017).

Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012).

Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.

Original language	English
Pages (from-to)	96-104
Number of pages	9
Journal	British Journal of Surgery
Volume	109
Issue number	1
DOIs	https://doi.org/10.1093/bjs/znab345
Publication status	Published - Jan 2022

Keywords

INTERNATIONAL STUDY-GROUP
VEIN RECONSTRUCTION
CONSENSUS STATEMENT
SURGERY
DEFINITION
CLASSIFICATION
GUIDELINES
MORTALITY
OPERATION
ALLOGRAFT

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10.1093/bjs/znab345Licence: CC BY-NC

Cite this

Groen, J. V., Michiels, N., van Roessel, S., Besselink, M. G., Bosscha, K., Busch, O. R., van Dam, R., van Eijck, C. H. J., Koerkamp, B. G., van der Harst, E., de Hingh, I. H., Karsten, T. M., Lips, D. J., de Meijer, V. E., Molenaar, I. Q., Nieuwenhuijs, V. B., Roos, D., van Santvoort, H. C., Wijsman, J. H., ... Dutch Pancreatic Cancer Group (2022). Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis. British Journal of Surgery, 109(1), 96-104. https://doi.org/10.1093/bjs/znab345

@article{99a67d772202428a9ee0f4a7e230977c,

title = "Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis",

abstract = "Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival.Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013–2017).Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012).Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.",

keywords = "INTERNATIONAL STUDY-GROUP, VEIN RECONSTRUCTION, CONSENSUS STATEMENT, SURGERY, DEFINITION, CLASSIFICATION, GUIDELINES, MORTALITY, OPERATION, ALLOGRAFT",

author = "Groen, {Jesse V} and Nynke Michiels and {van Roessel}, Stijn and Besselink, {Marc G} and Koop Bosscha and Busch, {Olivier R} and {van Dam}, Ronald and {van Eijck}, {Casper H J} and Koerkamp, {Bas Groot} and {van der Harst}, Erwin and {de Hingh}, {Ignace H} and Karsten, {Tom M} and Lips, {Daan J} and {de Meijer}, {Vincent E} and Molenaar, {Isaac Q} and Nieuwenhuijs, {Vincent B} and Daphne Roos and {van Santvoort}, {Hjalmar C} and Wijsman, {Jan H} and Fennie Wit and {de Vos-Geelen}, Judith and Wasser, {Martin N} and Bonsing, {Bert A} and Stommel, {Martijn W J} and Mieog, {J Sven D} and {Dutch Pancreatic Cancer Group}",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2022",

month = jan,

doi = "10.1093/bjs/znab345",

language = "English",

volume = "109",

pages = "96--104",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Wiley",

number = "1",

}

Groen, JV, Michiels, N, van Roessel, S, Besselink, MG, Bosscha, K, Busch, OR, van Dam, R, van Eijck, CHJ, Koerkamp, BG, van der Harst, E, de Hingh, IH, Karsten, TM, Lips, DJ, de Meijer, VE, Molenaar, IQ, Nieuwenhuijs, VB, Roos, D, van Santvoort, HC, Wijsman, JH, Wit, F, de Vos-Geelen, J, Wasser, MN, Bonsing, BA, Stommel, MWJ, Mieog, JSD & Dutch Pancreatic Cancer Group 2022, 'Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis', British Journal of Surgery, vol. 109, no. 1, pp. 96-104. https://doi.org/10.1093/bjs/znab345

Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis. / Groen, Jesse V; Michiels, Nynke; van Roessel, Stijn et al.
In: British Journal of Surgery, Vol. 109, No. 1, 01.2022, p. 96-104.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer

T2 - impact on short- and long-term outcomes in a nationwide cohort analysis

AU - Groen, Jesse V

AU - Michiels, Nynke

AU - van Roessel, Stijn

AU - Besselink, Marc G

AU - Bosscha, Koop

AU - Busch, Olivier R

AU - van Dam, Ronald

AU - van Eijck, Casper H J

AU - Koerkamp, Bas Groot

AU - van der Harst, Erwin

AU - de Hingh, Ignace H

AU - Karsten, Tom M

AU - Lips, Daan J

AU - de Meijer, Vincent E

AU - Molenaar, Isaac Q

AU - Nieuwenhuijs, Vincent B

AU - Roos, Daphne

AU - van Santvoort, Hjalmar C

AU - Wijsman, Jan H

AU - Wit, Fennie

AU - de Vos-Geelen, Judith

AU - Wasser, Martin N

AU - Bonsing, Bert A

AU - Stommel, Martijn W J

AU - Mieog, J Sven D

AU - Dutch Pancreatic Cancer Group

PY - 2022/1

Y1 - 2022/1

N2 - Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival.Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013–2017).Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012).Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.

AB - Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival.Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013–2017).Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012).Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.

KW - INTERNATIONAL STUDY-GROUP

KW - VEIN RECONSTRUCTION

KW - CONSENSUS STATEMENT

KW - SURGERY

KW - DEFINITION

KW - CLASSIFICATION

KW - GUIDELINES

KW - MORTALITY

KW - OPERATION

KW - ALLOGRAFT

U2 - 10.1093/bjs/znab345

DO - 10.1093/bjs/znab345

M3 - Article

C2 - 34791069

SN - 0007-1323

VL - 109

SP - 96

EP - 104

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 1

ER -