Background
Methods
Database and recorded parameters
Venous resection (VR) (n = 54) | No venous resection (NVR) (n = 102) | p-value1 | |||
---|---|---|---|---|---|
Sex | 0.24 | ||||
M | 27 | (50.0 %) | 61 | (59.8 %) | |
F | 27 | (50.0 %) | 41 | (40.2 %) | |
Age, mean (STD). yrs | 67.8 | (10.7) | 67.2 | (11) | 0.95 |
Preoperative performance status | |||||
ASA | 0.86 | ||||
1 | 3 | (5.6 %) | 8 | (7.8 %) | |
2 | 31 | (57.4 %) | 58 | (56.9 %) | |
3 | 20 | (37.0 %) | 36 | (35.3 %) | |
Diabetes mellitus | 16 | (29.6 %) | 27 | (26.5 %) | 0.67 |
Bile duct stent | 18 | (33.3 %) | 39 | (38.2 %) | 0.54 |
Pancreatitis | 2 | (3.7 %) | 12 | (11.8 %) | 0.09 |
Neoadjuvant treatment | 4 | (7.4 %) | 6 | (5.9 %) | 0.43 |
Type of Surgery | 0.001 | ||||
pp-Whipple | 25 | (46.3 %) | 63 | (61.7 %) | |
cl-Whipple | 8 | (14.8 %) | 6 | (5.9 %) | |
TP | 16 | (29.6 %) | 9 | (8.8 %) | |
DP | 5 | (9.3 %) | 22 | (21.7 %) | |
DPH | 0 | 2 | (1.9 %) | ||
Vein resection technique | |||||
End-to-End-Anastomosis | 33 | (61.1 %) | |||
Wedge-Resection | 15 | (27.8 %) | |||
goretex™ graft | 6 | (11.1 %) | |||
Operative time, mean (STD), min. | 378 | (103) | 317 | (85) | <0.0012 |
Blood transfusion | 9 | (16,7 %) | 4 | (4,0 %) | 0.012 |
Adjuvant chemotherapy | 46 | (85.2 %) | 87 | (85.3 %) | 0.97 |
Pathological findings | |||||
Tumor grade of differentiation | 0.28 | ||||
G1 | 1 | (1.8 %) | 8 | (7.8 %) | |
G2 | 25 | (46.3 %) | 41 | (40.2 %) | |
G3 | 28 | (51.9 %) | 53 | (52.0 %) | |
T-stage | 0.36 | ||||
T1 | 1 | (1.8 %) | 4 | (3.9 %) | |
T2 | 3 | (5.6 %) | 7 | (6.9 %) | |
T3 | 41 | (75.9 %) | 83 | (81.4 %) | |
T4 | 9 | (16.7 %) | 8 | (7.8 %) | |
Tumor size in cm (median, min-max) | 4.3 | 1.5-12 | 3.5 | 1.2-8.5 | 0.0263 |
Nodal status | 0.82 | ||||
0 | 16 | (29.6 %) | 32 | (31.4 %) | |
1 | 38 | (70.4 %) | 70 | (68.6 %) | |
Number of lymph nodes (median, min-max) | 21 | (5–62) | 20 | (7–54) | 0.92 |
Resection margins | 0.0464 | ||||
R0 | 22 | (40.8 %) | 60 | (58.8 %) | |
R1 | 24 | (44.4 %) | 31 | (30.4 %) | |
R2 | 0 | 1 | (1.0 %) | ||
Rx | 8 | (14.8 %) | 10 | (9.8 %) | |
Pathology report: venous infiltration | |||||
no | 8 | (14.8 %) | |||
yes | 19 | (35.2 %) | |||
unkown | 27 | (50.0 %) |
Inclusion and exclusion criteria
Statistics
Results
Analysis of venous resection
Venous resection VR (n = 54) | No venous resection NVR (n = 102) | p-value1 | |||
---|---|---|---|---|---|
Postoperative complications2 | 0.38 | ||||
Grade I | 12 | 22.2 % | 15 | 14.71 % | 0.19 |
Grade II3 | 19 | 35.2 % | 38 | 37.3 % | 0.86 |
Grade III | 8 | 14.8 % | 9 | 8.8 % | 0.28 |
Grade IV | 1 | 1.8 % | 1 | 1.0 % | 1.00 |
120 day mortality4 | 3 | 5.3 % | 3 | 2.9 % | 0.37 |
Portal vein thrombosis | |||||
30 days | 1 | 1.8 % | 1 | 1.0 % | 0.69 |
total | 7 | 13.0 % | 1 | 1.0 % | 0.001 |
Pancreatic fistula, grade C | 2 | 3.7 % | 4 | 3.9 % | |
Lymph fistula | 2 | 3.7 % | 3 | 2.9 % | |
Delayed gastric emptying | 6 | 11.1 % | 4 | 3.9 % | 0.09 |
Diarrhea | 4 | 7.4 % | 4 | 3.9 % | |
Intraabdominalabscess | 2 | 3.7 % | 5 | 4.9 % | |
Cholangitis | 3 | 5.6 % | 15 | 14.7 % | 0.11 |
Wound infection | 3 | 5.6 % | 8 | 7.8 % | |
Liver ischemia | 1 | 1.8 % | 0 | 0.0 % | |
Bleeding | 2 | 3.7 % | 0 | 0.0 % | |
Re-operation | 2 | 3.7 % | 3 | 2.9 % | |
Pneumonia | 0 | 0.0 % | 1 | 1.0 % | |
Urinary tract infection | 2 | 3.7 % | 2 | 2.0 % | |
Cardiac dysfunction | 1 | 1.8 % | 3 | 2.9 % |
No venous invasion (n = 8) | Venous invasion (n = 19) | p-value1 | |||
---|---|---|---|---|---|
Sex | 0.33 | ||||
M | 5 | (62.3 %) | 8 | (42.1 %) | |
F | 3 | (37.4 %) | 11 | (57.9 %) | |
Age, mean (STD), yrs | 61.7 | (13.2) | 65.0 | (10.3) | 0.48 |
Preoperative performance status | |||||
ASA | 0.23 | ||||
1/2 | 4 | (50.0 %) | 14 | (73.7 %) | |
3 | 4 | (50.0 %) | 5 | (26.3 %) | |
Diabetes mellitus | 1 | (12.5 %) | 6 | (31.6 %) | 0.41 |
Bile duct stent | 2 | (25.0 %) | 11 | (57.9 %) | 0.23 |
Type of surgery | 0.55 | ||||
ppWhipple/cl-Whipple | 6 | (75.0 %) | 12 | (63.2 %) | |
TP | 2 | (25.0 %) | 7 | (36.8 %) | |
Vein resection technique | 0.19 | ||||
End-to-End anastomosis | 6 | (75.0 %) | 15 | (78.9 %) | |
Wedge- Resection | 2 | (25.0 %) | 1 | (5.3 %) | |
goretex™ graft | 0 | 3 | (15.8 %) | ||
Operative time, mean (STD), min. | 416 | (42) | 379 | (85) | 0.2222 |
c3 | 0.52 | ||||
Grade I/II | 4 | (50.0 %) | 11 | (57.9 %) | |
Grade III/IV | 2 | (25.0 %) | 4 | (21.1 %) | |
Pathological findings | |||||
Tumor grade of differentiation | 0.47 | ||||
G1/G2 | 6 | (75.0 %) | 9 | (47.4 %) | |
G3 | 2 | (25.0 %) | 10 | (52.6 %) | |
T-stage | 0.001 | ||||
T1/T2 | 4 | (50.0 %) | 0 | ||
T3/T4 | 4 | (50.0 %) | 19 | (100.0 %) | |
Nodal status | 0.038 | ||||
N0 | 6 | (75.0 %) | 6 | (31.6 %) | |
N1 | 2 | (25.0 %) | 13 | (68.4 %) | |
Resection margins | 0.36 | ||||
R0 | 4 | (50.0 %) | 6 | (31.6 %) | |
R1 (incl. RX) | 4 | (50.0 %) | 13 | (68.5 %) | |
Localization of tumor | 0.099 | ||||
Pancreatic head | 7 | (87.5 %) | 14 | (73.7 %) | |
Multifocal | 1 | (12.5 %) | 5 | (26.3 %) | |
Pre-operative prediction venous infiltration | |||||
CT/MRT+ | 5 | 11 | Sensitivity: 0.69 | ||
CT/MRT- | 2 | 5 | Specificity: 0.29 |