Overcoming the technical challenge of venous resection with pancreatectomy: Which factors determine survival?

Elena B Rangelova; Poya Ghorbani; Roberto Valente; Kimitaka Tanaka; Asif Halimi; Urban Arnelo; Ralf Segersvärd; Ernesto Sparrelid; Marco Del Chiaro

doi:10.1016/j.ejso.2025.109629

Overcoming the technical challenge of venous resection with pancreatectomy: Which factors determine survival?

Eur J Surg Oncol. 2025 Aug;51(8):109629. doi: 10.1016/j.ejso.2025.109629. Epub 2025 Jan 23.

Authors

Elena B Rangelova¹, Poya Ghorbani², Roberto Valente³, Kimitaka Tanaka⁴, Asif Halimi³, Urban Arnelo³, Ralf Segersvärd⁵, Ernesto Sparrelid², Marco Del Chiaro⁶

Affiliations

¹ Department of Surgery, Section for Upper Abdominal Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: elena.rangelova@gu.se.
² Division of Surgery and Oncology, Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Diagnostics and Intervention (DDI)/Surgery, Umeå University, Sweden.
⁴ Department of Gastroenterological Surgery II, Hokkaido University, Faculty of Medicine, Hokkaido, Japan.
⁵ Regional Cancer Center, Stockholm-Gotland, Sweden.
⁶ Division of Surgical Oncology, Department of Surgery - University of Colorado Anschutz Medical Campus, Denver, USA.

PMID: 39875262
DOI: 10.1016/j.ejso.2025.109629

Abstract

Background: Pancreatectomy with venous resection (PVR) is nowadays considered standard. However, there is still concern about increased postoperative morbidity and impaired long-term outcome depending on the type of venous resection and reconstruction. The aim was to investigate the predictors of morbidity and long-term survival in patients undergoing PVR in a high-volume center.

Methods: All consecutive patients undergoing PVR at a single center between January 2008 and January 2019 were retrieved from a prospectively maintained database. Factors associated with postoperative complications and long-term survival were analyzed.

Results: Of 290 patients with isolated PVRs, 188 (65 %) were performed for pancreatic ductal adenocarcinoma (PDAC). Surgical complications developed in 56 % of patients (n = 163), and 11 % (n = 36) had severe complications (Clavien-Dindo>3a). The 90-day mortality was 4.1 %. Venous thrombosis occurred in 4.8 % (n = 14), resulting in one mortality (0.3 %). No technical factors were predictive for the development of severe complications. Longer vein segments >3 cm could be resected with similar short- and long-term outcome as shorter segments. The survival of patients undergoing PVR for resectable, borderline and locally advanced PDAC was similar (median of 18, 14, and 23 months, p = 0.7). On multivariate analysis, elevated CA19-9>200 U/mL and ASA score≥3 were independent predictors of survival (p = 0.02), but not resectability at diagnosis nor type of venous reconstruction.

Conclusion: The type of venous resection/reconstruction does not influence outcome and should be tailored according to patients' and tumors' characteristics during PVR. The long-term survival after PVR for PDAC is influenced by tumor-and patient-related characteristics, and not technical vascular-resection associated factors.

Keywords: Complications; Pancreatectomy; Pancreatic cancer; Survival; Venous resection.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal* / mortality
Carcinoma, Pancreatic Ductal* / pathology
Carcinoma, Pancreatic Ductal* / surgery
Female
Humans
Male
Mesenteric Veins* / surgery
Middle Aged
Pancreatectomy* / methods
Pancreatic Neoplasms* / mortality
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Portal Vein* / surgery
Postoperative Complications* / epidemiology
Retrospective Studies
Survival Rate
Vascular Surgical Procedures / methods
Venous Thrombosis / epidemiology