Abstract Background Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival. Methods This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013–2017). Results A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P = 0.012). Conclusion In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection.

中文翻译：

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胰腺癌胰十二指肠切除术中的静脉楔形和节段切除：全国队列分析中对短期和长期结果的影响

摘要 背景肠系膜上静脉或门静脉切除术在胰腺癌手术中越来越多地进行，但短期和长期结果的研究结果是矛盾的。本研究的目的是评估胰腺癌胰十二指肠切除术中静脉切除类型对术后发病率和总生存率的影响。 方法这项全国性回顾性队列研究纳入了 18 个中心（2013-2017 年）因胰腺癌接受胰十二指肠切除术的所有患者。 结果总共纳入了 1311 名患者，其中 17% 接受了楔形切除术，10% 接受了节段切除术。接受节段切除的患者主要发病率较高（分别为 39% vs 20% vs 23%；P < 0.001），门静脉或肠系膜上静脉血栓形成率较高（分别为 18% vs 5% vs 1%；P < 0.001）。与接受楔形切除的患者和未接受静脉切除的患者相比，总生存期更差（中位生存期分别为 12 个月、16 个月和 20 个月；P < 0.001）。多变量分析显示，接受节段切除的患者，而非接受楔形切除的患者，主要发病率较高（比值比 = 1.93，95% ci 1.20 至 3.11），总体生存率较差（风险比 = 1.40，95% ci） 1.10 至 1.78），与未进行静脉切除的患者相比。在接受新辅助治疗的患者中，尽管主要发病率存在差异，但接受节段性切除术和楔形切除术的患者与未接受静脉切除术的患者的总生存期没有差异（中位生存期分别为 32 个月、25 个月和 33 个月；P = 0.470）。率（分别为 52%、19% 和 21%；P = 0.012）。 结论在胰腺手术中，与楔形切除术和未进行静脉切除术的患者相比，接受静脉段切除术的患者的短期和长期结果更差。