Skip to main content

Advertisement

SpringerLink
Log in

The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence

  • Review Article
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

The prognostic significance of portal/superior mesenteric vein (PV/SMV) invasion at the time of pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) is contentious. The aim of this meta-analysis was to compare the survival outcomes in patients with histologically proven adventitial (superficial) versus media/intimal (deep) PV/SMV invasion at the time of PD for PDAC.

Methods

A systematic search of the PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. All articles reporting outcomes specific to the depth of PDAC invasion into the PV/SMV wall were included. The primary outcome measure was overall survival.

Results

Six studies including 310 patients who underwent pancreatic resection with PV/SMV resection for PDAC were included in this meta-analysis. There was no difference in overall survival comparing superficial vs deep invasion at 12 months (64% vs 58% respectively, risk difference, − 0.09; CI, − 0.21–0.04; P = 0.183), 36 months (22% vs 18% respectively, risk difference, − 0.05; CI, − 0.16–0.19; P = 0.857) and mean overall survival (42.8 months vs 25.7 months respectively, standard mean difference, − 0.27; CI, − 0.58, 0.03; P = 0.078). Although larger tumours were seen in those with confirmed deep vein wall invasion (P < 0.001), no difference was observed between the superficial and deep invasion groups with regard to age (P = 0.298), R1 resection (P = 0.896), nodal metastatic disease (P = 0.120) and perineural invasion (P = 0.609).

Conclusions

This meta-analysis suggests that the depth of PV/SMV wall invasion by PDAC may not impact survival after PD. However, given the limited sample size, further research is warranted with homogenous cohorts and longer follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Allen PJ, Kuk D, Fernandez-del Castillo C, Basturk O, Wolfgang CL, Cameron JL, et al. Multi-institutional validation study of the American Joint Commission on Cancer changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg. 2017;265(1):185–91.

    Article  Google Scholar 

  2. Lowenfels AB, Maisonneuve P, Raimondi S. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6(12):699–708.

    Article  Google Scholar 

  3. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery (United States). 2014;155(6):977–88.

    Google Scholar 

  4. Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I. Meta-analysis of benefits of portal–superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg. 2016;103(3):179–91.

    Article  CAS  Google Scholar 

  5. Kleive D, Sahakyan MA, Berstad AE, Verbeke CS, Gladhaug IP, Edwin B, et al. Trends in indications, complications and outcomes for venous resection during pancreatoduodenectomy. Br J Surg. 2017;104(11):1558–67.

    Article  CAS  Google Scholar 

  6. Murakami Y, Satoi S, Motoi F, Sho M, Kawai M, Matsumoto I, et al. Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg. 2015;102(7):837–46.

    Article  CAS  Google Scholar 

  7. Song A, Liu F, Wu L, Si X, Zhou Y. Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis. Oncotarget. 2017;8(20):32600–7.

    Article  Google Scholar 

  8. Wang J, Estrella JS, Peng L, Rashid A, Varadhachary GR, Wang H, et al. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer. 2012;118(15):3801–11.

    Article  Google Scholar 

  9. Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg. 2003;186(2):149–53.

    Article  Google Scholar 

  10. Nakao A. Debate: extended resection for pancreatic cancer; the affirmative case. J Hepatobiliary Pancreat. 2003;10(1):57–60.

    Article  Google Scholar 

  11. Shimada K, Sano T, Sakamoto Y, Kosuge T. Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol. 2006;13(12):1569–78.

    Article  Google Scholar 

  12. Nakao A, Harada A, Nonami T, Kaneko T, Inoue S, Takagi H. Clinical significance of portal invasion by pancreatic head carcinoma. Surgery. 1995;117(1):50–5.

    Article  CAS  Google Scholar 

  13. Han S, Park S, Kim SH, Cho SY, Kim Y, Kim TH, et al. Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer. Pancreas. 2012;41(1):102–6.

    Article  CAS  Google Scholar 

  14. Boggi U, Del Chiaro M, Croce C, Vistoli F, Signori S, Moretto C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery. 2009;146(5):869–81.

    Article  Google Scholar 

  15. Nakao A, Kanzaki A, Fujii T, Kodera Y, Yamada S, Sugimoto H, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255(1):103–8.

    Article  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  Google Scholar 

  17. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.

    Article  CAS  Google Scholar 

  18. Ankit Rohatgi. WebPlotDigitizer 4.0. 2017; Available at: https://automeris.io/WebPlotDigitizer. Accessed October, 2017.

  19. Ravikumar R, Sabin C, Abu Hilal M, Al-Hilli A, Aroori S, Bond-Smith G, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Br J Surg. 2017;104(11):1539–48.

    Article  CAS  Google Scholar 

  20. Campbell F, Smith RA, Whelan P, Sutton R, Raraty M, Neoptolemos JP, et al. Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology. 2009;55(3):277–83.

    Article  Google Scholar 

  21. Cochrane. Review Manager version 5.3. Available at: http://tech.cochrane.org/revman/download. Accessed October, 2017.

  22. Higgins J, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  Google Scholar 

  23. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  Google Scholar 

  24. Rhee H, Suurmond R, Hak T User manual for meta-essentials: workbooks for meta-analyses (Version 1.0). 2015.

  25. Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, et al. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma: commentary. Arch Surg (Chicago, Ill: 1960). 2007;142(2):180.

    Article  Google Scholar 

  26. Jeong J, Choi DW, Choi SH, Heo JS, Jang K. Long-term outcome of portomesenteric vein invasion and prognostic factors in pancreas head adenocarcinoma. ANZ J Surg. 2015;85(4):264–9.

    Article  Google Scholar 

  27. Addeo P, Velten M, Averous G, Faitot F, Nguimpi-Tambou M, Nappo G, et al. Prognostic value of venous invasion in resected T3 pancreatic adenocarcinoma: depth of invasion matters. Surgery. 2017;162(2):264–74.

    Article  Google Scholar 

  28. Roch AM, House MG, Cioffi J, Ceppa EP, Zyromski NJ, Nakeeb A, et al. Significance of portal vein invasion and extent of invasion in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg: official journal of the Society for Surgery of the Alimentary Tract. 2016;20(3):479–87.

    Article  Google Scholar 

  29. Takahashi S, Ogata Y, Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer. Hepatogastroenterology. 1994;81(8):1190–3.

    CAS  Google Scholar 

  30. Suurmond R, Rhee H, Hak T. Introduction, comparison, and validation of meta-essentials: a free and simple tool for meta-analysis. Res Synth Methods. 2017;8(4):537–53.

    Article  Google Scholar 

  31. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327(7414):557–60.

    Article  Google Scholar 

  32. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155(6):977–88.

    Article  Google Scholar 

  33. Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, et al. Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg. 2001;25(8):1002–5.

    Article  CAS  Google Scholar 

  34. Kaneoka Y, Yamaguchi A, Isogai M. Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery. 2009;145(4):417–25.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Chathura B. B. Ratnayake & John A Windsor

  2. HPB unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand

    Chathura B. B. Ratnayake & John A Windsor

  3. Department of HPB Surgery, Northern General Hospital, Sheffield, UK

    Nehal Shah

  4. Department of HPB Surgery, Royal Melbourne Hospital, Melbourne, Australia

    Benjamin Loveday

  5. HPB and Transplant Unit, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK

    Sanjay Pandanaboyana

Authors
  1. Chathura B. B. Ratnayake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nehal Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Loveday
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John A Windsor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sanjay Pandanaboyana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanjay Pandanaboyana.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Committee Approval

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ratnayake, C.B.B., Shah, N., Loveday, B. et al. The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence. J Gastrointest Canc 51, 379–386 (2020). https://doi.org/10.1007/s12029-019-00248-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-019-00248-3

Keywords

Search

Navigation