Clinical Outcomes of Preservation Versus Resection of Portal/Superior Mesenteric Vein During Pancreaticoduodenectomy in Pancreatic Cancer Patients Who Respond to Neoadjuvant Treatment

Clinical Outcomes of Preservation Versus Resection of Portal/Superior Mesenteric Vein During Pancreaticoduodenectomy in Pancreatic Cancer Patients Who Respond to Neoadjuvant Treatment

1. There is a lack of evidence on the need to perform portal/superior mesenteric vein (PV/SMV) resection routinely in pancreatic ductal adenocarcinoma (PDAC) patients with venous involvement who responded to neoadjuvant treatment (NAT).
2. There is no significant differences in R0 rate, 5-year overall survival and recurrence-free survival between the PV/SMV preservation (PVP) group and PV/SMV resection (PVR) group.
3. PVP group showed significantly better 5-year PV/SMV stenosis free survival than the PVR group.
4. We propose that if dissection is possible and there is a high likelihood of achieving R0 resection after NAT, routine PVR may be unnecessary in PDAC patients with venous involvement.

Inclusion Criteria:

• Pancreatic head cancer patients who underwent surgery after neoadjuvant treatment between January 2012 and December 2022 at Seoul National University Hospital

Exclusion Criteria:

• Metastatic unresectable and locally advanced pancreatic cancer
• Resectable pancreatic cancer without portal/superior mesenteric vein invasion
• Cancer aggravation after neoadjuvant treatment
• Portal/superior mesenteric vein encasing and narrowing after neoadjuvant treatment
• Patients who underwent palliative surgery
• Non-pancreatic ductal adenocarcinoma patients
• Patients who death within 30 days of surgery
• Loss of follow-up patients
• Patients who underwent resection for suspected main artery and adjacent organ invasion