Venous resection for pancreatic cancer, a safe and feasible option?: A systematic review and meta-analysis

E. S. Zwart; B. S. Yilmaz; A. Halimi; R. Ahola; B. Kurlinkus; J. Laukkarinen; G. O. Ceyhan

doi:10.1016/j.pan.2022.05.001

Venous resection for pancreatic cancer, a safe and feasible option? A systematic review and meta-analysis

E. S. Zwart
, B. S. Yilmaz
, A. Halimi
, R. Ahola
, B. Kurlinkus
, J. Laukkarinen
, G. O. Ceyhan^*

^*Corresponding author for this work

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

42 Citations (Scopus)

Abstract

Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). Methods: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Results: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. Conclusion: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.

Original language	English
Journal	Pancreatology
Volume	22
Issue number	6
DOIs	https://doi.org/10.1016/j.pan.2022.05.001
Publication status	Published - 2022
Publication type	A2 Review article in a scientific journal

Funding

This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute, and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isojärvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation, The Netherlands (CCA); the Lithuanian Gastroenterology Society, Lithuania; Mylan, The Netherlands; State Research Funding (VTR), Finland; and the Sigrid Jusélius Foundation, Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions. This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute , and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isojärvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation , The Netherlands (CCA); the Lithuanian Gastroenterology Society , Lithuania; Mylan, The Netherlands; State Research Funding (VTR) , Finland; and the Sigrid Jusélius Foundation , Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Carcinoma
Mesenteric vein
Pancreatectomy
Pancreatic neoplasms
Portal vein

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Hepatology
Gastroenterology

Access to Document

10.1016/j.pan.2022.05.001

Cite this

@article{dc46114e30a944dcaf51006d60d8477e,

title = "Venous resection for pancreatic cancer, a safe and feasible option?: A systematic review and meta-analysis",

abstract = "Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). Methods: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Results: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5\% vs. 5.6\%), R1 resections (36.7\% vs. 28.6\%), N1 resections (70.3\% vs. 66.8\%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6\% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. Conclusion: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.",

keywords = "Carcinoma, Mesenteric vein, Pancreatectomy, Pancreatic neoplasms, Portal vein",

author = "Zwart, \{E. S.\} and Yilmaz, \{B. S.\} and A. Halimi and R. Ahola and B. Kurlinkus and J. Laukkarinen and Ceyhan, \{G. O.\}",

note = "Funding Information: This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute, and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isoj{\"a}rvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation, The Netherlands (CCA); the Lithuanian Gastroenterology Society, Lithuania; Mylan, The Netherlands; State Research Funding (VTR), Finland; and the Sigrid Jus{\'e}lius Foundation, Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions. Funding Information: This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute , and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isoj{\"a}rvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation , The Netherlands (CCA); the Lithuanian Gastroenterology Society , Lithuania; Mylan, The Netherlands; State Research Funding (VTR) , Finland; and the Sigrid Jus{\'e}lius Foundation , Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions. Publisher Copyright: {\textcopyright} 2022",

year = "2022",

doi = "10.1016/j.pan.2022.05.001",

language = "English",

volume = "22",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "Elsevier",

number = "6",

}

TY - JOUR

T1 - Venous resection for pancreatic cancer, a safe and feasible option?

T2 - A systematic review and meta-analysis

AU - Zwart, E. S.

AU - Yilmaz, B. S.

AU - Halimi, A.

AU - Ahola, R.

AU - Kurlinkus, B.

AU - Laukkarinen, J.

AU - Ceyhan, G. O.

N1 - Funding Information: This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute, and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isojärvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation, The Netherlands (CCA); the Lithuanian Gastroenterology Society, Lithuania; Mylan, The Netherlands; State Research Funding (VTR), Finland; and the Sigrid Jusélius Foundation, Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions. Funding Information: This study was conducted as a project of the 9th Pancreas 2000 Education and Research Program funded by the Acibadem Mehmet Ali Aydinlar University, the Karolinska Institute , and the European Pancreatic Club/EPC. We would like to thank Friedrich Anger, Martin David, Peter Dubovan, Vojko Flis, Anthony Gill and Giuseppe Malleo for supplying us with the original survival data of their studies. Furthermore, we would like to thank Jaana Isojärvi and Hans Ket for contributing to our search strategy and Virginia Mattila for proofreading the manuscript. The authors received funding from Cancer Center Amsterdam Foundation , The Netherlands (CCA); the Lithuanian Gastroenterology Society , Lithuania; Mylan, The Netherlands; State Research Funding (VTR) , Finland; and the Sigrid Jusélius Foundation , Finland. Funding had no involvement in the study design, data collection, data analysis, manuscript preparation, or publication decisions. Publisher Copyright: © 2022

PY - 2022

Y1 - 2022

N2 - Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). Methods: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Results: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. Conclusion: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.

AB - Background: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). Methods: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. Results: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. Conclusion: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.

KW - Carcinoma

KW - Mesenteric vein

KW - Pancreatectomy

KW - Pancreatic neoplasms

KW - Portal vein

U2 - 10.1016/j.pan.2022.05.001

DO - 10.1016/j.pan.2022.05.001

M3 - Review Article

AN - SCOPUS:85131821946

SN - 1424-3903

VL - 22

JO - Pancreatology

JF - Pancreatology

IS - 6

ER -