Immediate outcomes of pancreatoduodenalectomy in multivisceral surgery with vascular resection

Purpose: to study the immediate outcomes of pancreaticoduodenalectomy (PD) in multivisceral surgeries (MVS) with vascular resections. Material and Methods. The study included 145 patients who underwent pancreaticoduodenalectomy with resection of the major vessels, including the superior mesenteric vein, the portal vein, and the inferior vena cava. These patients were divided into two groups. The main group included 32 patients who underwent MVS with PD, and the control group consisted of 113 patients who underwent PD. Results. There were no statistically significant differences in the immediate outcomes between two groups. Pancreatic fistula developed more often in the MVS with PD group than in the PD group (25 vs 11.5 %, p=0.055). The incidence of resected vein thrombosis in the main group was 9.4 %, in the control group was 1.8 % (p=0.07). Postoperative intra-abdominal bleeding was 6.2 % vs 8 % (p=1.0). Postoperative mortality was 6.2 % in the MVS with PD group and 8.8 % in the PD group (p=1.0). True vascular invasion was confirmed by pathomorphological examination in 20 (64.5 %) cases in the MVS with PD group and in 81 (71.7 %) cases in the PD group (p=0.44). Conclusion. Although no statistically significant differences were observed between the two groups, venous resections in multivisceral surgeries involving pancreaticoduodenalectomy demonstrated a higher incidence of pancreatodigestive anastomosis complications and a higher frequency of venous thrombosis compared to pancreaticoduodenalectomy without resection of adjacent organs, which must be taken into account when planning surgery and managing the postoperative period of this category of patients.

1. Naffouje S.A., Pointer D.T. Jr., Satyadi M.A., Hodul P., Anaya D.A., Pimiento J., Malafa M., Kim D.W., Fleming J.B., Denbo J.W. Surgical approach to pancreaticoduodenectomy for pancreatic adenocarcinoma: uncomplicated ends justify the means. Surg Endosc. 2022; 36(7): 4912–22. doi: 10.1007/s00464-021-08845-9.

2. Kokkinakis S., Kritsotakis E.I., Maliotis N., Karageorgiou I., Chrysos E., Lasithiotakis K. Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2022; 21(6): 527–37. doi: 10.1016/j.hbpd.2022.04.006.

3. Zagainov V.E., Kiselev N.M., Kolesnik Ya.I., Kuchin D.M. Vascular complications of pancreaticoduodenal resection: prevention and treatment. Problems in Oncology. 2024; 70(2): 360–67. (in Russian). doi: 10.37469/0507-3758-2024-70-2-360-367. EDN: QTSIYQ.

4. Oba A., Bao Q.R., Barnett C.C., Al-Musawi M.H., Croce C., Schulick R.D., Del Chiaro M. Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC. Scand J Surg. 2020; 109(1): 18–28. doi: 10.1177/1457496919900413.

5. Mohammed S., Mendez-Reyes J.E., McElhany A., Gonzales-Luna D., van Buren G., Bland D.S., Villafane-Ferriol N., Pierzynski J.A., West C.A., Silberfein E.J., Fisher W.E. Venous thrombosis following pancreaticoduodenectomy with venous resection. J Surg Res. 2018; 228: 271–80. doi: 10.1016/j.jss.2018.02.006.

6. Kit O.I., Katelnitskaya O.V., Maslov A.A., Gevorkyan Yu.A., Kolesnikov E.N. Venous resections and reconstructions in surgery of pancreatic cancer. I.P. Pavlov Russian Medical Biological Herald. 2020; 2 8(3): 340–49. (in Russian). doi: 10.23888/PAVLOVJ2020283340-349. EDN: ZECJSW.

7. Giuliani T., Di Gioia A., Andrianello S., Marchegiani G., Bassi C. Pancreatoduodenectomy associated with colonic resections: indications, pitfalls, and outcomes. Updates Surg. 2021; 73(2): 379–90. doi: 10.1007/s13304-021-00996-7.

8. Mizuno T., Ebata T., Yokoyama Y., Igami T., Yamaguchi J., Onoe S., Watanabe N., Ando M., Nagino M. Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. Br J Surg. 2019; 106(5): 626–35. doi: 10.1002/bjs.11088.

9. Roberts P., Seevaratnam R., Cardoso R., Law C., Helyer L., Coburn N. Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer. Gastric Cancer. 2012; 15(s1): 108–15. doi: 10.1007/s10120-011-0086-5.

10. Khalili M., Daniels L., Gleeson E.M., Grandhi N., Thandoni A., Burg F., Holleran L., Morano W.F., Bowne W.B. Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review. Surgery. 2019; 166(2): 223–29. doi: 10.1016/j.surg.2019.04.020.

11. Marino M.V., Giovinazzo F., Podda M., Gomez Ruiz M., Gomez Fleitas M., Pisanu A., Latteri M.A., Takaori K. Robotic-assisted pancreaticoduodenectomy with vascular resection. Description of the surgical technique and analysis of early outcomes. Surg Oncol. 2020; 35: 344–50. doi: 10.1016/j.suronc.2020.08.025.

12. Kauffmann E.F., Napoli N., Menonna F., Genovese V., Cacace C., Andrea C.I., Daniela C., Vistoli F., Amorese G., Boggi U. Robot-assisted pancreaticoduodenectomy with vascular resection: technical details and results from a high-volume center. Laparosc Surg. 2020; 4: 37.

13. Delpero J.R., Sauvanet A. Vascular Resection for Pancreatic Cancer: 2019 French Recommendations Based on a Literature Review From 2008 to 6-2019. Front Oncol. 2020; 10: 40. doi: 10.3389/fonc.2020.00040.

14. Zettervall S.L., Ju T., Holzmacher J.L., Rivas L., Lin P.P., Vaziri K. Neoadjuvant Radiation Is Associated with Fistula Formation Following Pancreaticoduodenectomy. J Gastrointest Surg. 2018; 22(6): 1026–33. doi: 10.1007/s11605-018-3725-x.

15. Kamarajah S.K., Bundred J.R., Boyle C., Oo J., Pandanaboyana S., Loveday B. Impact of neoadjuvant therapy on post-operative pancreatic fistula: a systematic review and meta-analysis. ANZ J Surg. 2020; 90(11): 2201–10. doi: 10.1111/ans.15885.

16. Zwart E.S., Yilmaz B.S., Halimi A., Ahola R., Kurlinkus B., Laukkarinen J., Ceyhan G.O. Venous resection for pancreatic cancer, a safe and feasible option?A systematic review and meta-analysis. Pancreatology. 2022; 22(6): 803–9. doi: 10.1016/j.pan.2022.05.001.