Tangential versus segmental portomesenteric venous resection in pancreatic surgery—impact on recurrence and survival
Paulina Bereza-Carlson, Bodil AnderssonAbstract
Introduction
Portomesenteric venous resection enables curative-intent pancreatic surgery in borderline and locally advanced disease. This study aimed to investigate whether the type of venous resection influences oncological outcomes, including recurrence patterns.
Methods
Patients undergoing pancreatic surgery with venous resection at a single centre (2010–2022) were retrospectively analysed and stratified according to the type of venous resection—tangential or segmental. Baseline characteristics, perioperative outcomes, recurrence, and survival were assessed. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan–Meier method and compared using log-rank tests. Multivariable Cox regression was performed to identify predictors of survival.
Results
A total of 105 patients were included (tangential n = 60, segmental n = 45). Baseline characteristics were comparable. Segmental resection was associated with longer operative time, greater blood loss, and higher transfusion rates. Major and surgical complications were similar, whereas medical complications were more frequent following segmental resection (n = 9 (15%) versus n = 15 (33%), P = 0.027). The ability to undergo adjuvant chemotherapy was comparable (n = 55 (92%) versus n = 39 (87%), P = 0.408). Recurrence patterns did not differ (P = 0.765), and RFS was similar (median 17 versus 11 months, log-rank P = 0.087). OS was also comparable (log-rank P = 0.405), with median survival of 2.4 versus 2.0 years. In multivariable analysis, venous resection type was not associated with OS (HR 0.86, 95% c.i. 0.53–1.4, P = 0.555), nor were additional extended resections (HR 0.52, 95% c.i. 0.2–1.6, P = 0.242).
Discussion
Segmental venous resection increases operative complexity and medical morbidity without compromising oncological outcomes, including recurrence and overall survival.