Pre-operatively available prognostic factors for survival in pancreatic cancer patients undergoing pancreatoduodenectomy with venous resection
Adrienne Molnár, Oskar Hemmingsson, Malin Sund, Bodil Andersson, Oskar FranklinAbstract
Introduction
Venous resection is performed during pancreatic surgery to achieve cancer-free margins. This study aimed to explore the prognostic value of pre-operatively available factors for survival in patients undergoing pancreatoduodenectomy with concomitant venous resection.
Methods
This retrospective study used the Swedish National Pancreatic Cancer Registry to identify patients with resectable or borderline resectable pancreatic adenocarcinoma undergoing pancreatoduodenectomy in 2017–2024. Pre-operatively available patient- and disease-specific factors were compared between patients with and without concomitant venous resection using chi-square and Mann-Whitney U tests. Predictive values for survival were explored with adjusted Cox proportional hazards models.
Results
Among the 1626 patients included, 410 (25.2%) underwent concomitant venous resection. Patients undergoing venous resection more often had borderline tumours (19.3% versus 3.6%, P < 0.001), received neoadjuvant therapy (17.8% versus 4.9%, P < 0.001), and presented with higher baseline CA19-9 (median: 146.7 versus 85.0, P = 0.016). Postoperative pancreatic fistulae were less common among patients undergoing venous resection (5.0% versus 9.8%, P < 0.001), while post-pancreatectomy hemorrhage, bile leakage, delayed gastric emptying, and postoperative morbidity were similar between the groups. Worse survival associations were found for elevated C-reactive protein (HR 1.62; 95% c.i. 1.18–2.22, P = 0.003), diabetes (HR 1.44; 95% c.i. 1.03–2.02, P = 0.032), and pulmonary disease (chronic obstructive pulmonary disease, dyspnea at conversation and/or at rest) (HR 2.11; 95% c.i. 1.23–3.61, P = 0.006). Unintentional weight loss was associated with improved survival (HR 0.70; 95% c.i. 0.52–0.94, P = 0.019).
Discussion
Elevated C-reactive protein, diabetes, and pulmonary disease are associated with poor prognosis, while unintentional weight loss is associated with improved prognosis in patients undergoing venous resection.