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Saburo Fukuda, MD; Elie Oussoultzoglou, MD; Philippe Bachellier, MD; Edoardo Rosso, MD; Hiroshi Nakano, MD, PhD; Maxime Audet, MD; Daniel Jaeck, MD, PhD, FRCS

Arch Surg. 2007;142(2):172-179.

Hypothesis  The depth of portal vein (PV) wall invasion is a prognostic factor for survival after curative pancreatic resection for pancreatic ductal adenocarcinoma.

Design  Retrospective clinical study.

Setting  Department of digestive surgery and transplantation.

Patients  From January 1, 1990, through December 31, 2002, 121 patients underwent a curative pancreatic resection for ductal adenocarcinoma of the pancreas. Among these, 37 pancreatic resections combined with PV resection were performed.

Main Outcome Measures  Prognostic factors for survival and predictive factors for the depth of PV wall invasion.

Results  The morbidity and mortality rates did not differ between patients undergoing or not undergoing PV resection (32.4% and 2.7% [1/37], respectively, vs 38.1% and 2.4% [2/84], respectively). The 3-year survival rate after curative pancreatic resection was significantly associated with the depth of PV wall invasion. Indeed, the 3-year overall survival rate was similar for patients with no PV invasion and those with superficial invasion into the tunica adventitia (40.0% vs 32.9%, respectively; P  = .85). Deeper PV wall invasion into the tunica media or the tunica intima was associated with a poorer 1-year survival rate similar to that of patients undergoing noncurative resection (21.5% vs 34.4%, respectively; P = .53). Multivariate analysis showed that the depth of PV wall invasion, number of involved lymph nodes, and volume of blood transfusion were independent factors of overall and disease-free survival. Tumor size of 45 mm or more (evaluated by computed tomography) and angiographic type C or D on a portogram were significantly correlated with the depth of PV wall invasion. Patients presenting with both factors simultaneously had poor survival.

Conclusions  The depth of PV wall invasion significantly alters survival after curative pancreatic resection combined with PV resection. However, occasional long-term survival could be observed after curative resection in patients with deep PV wall invasion.

Author Affiliations: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Université Louis Pasteur, Strasbourg, France.

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