Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Enrolled Patients
2.2. Clinicopathological Data Collection
2.3. Imaging Assessment
2.4. Prediction Model for Postoperative Variceal Formation
2.5. Comparison of Varix-Related Parameters and Oncologic Outcomes According to SV Status
2.6. Statistics
3. Results
3.1. Clinicopathological Characteristics
3.2. Prediction Model for Postoperative Variceal Formation
3.3. Characteristics between SV Saving and SV Ligation
3.4. Comparison of Varix-Related Parameters According to SV Status
3.5. Oncologic Outcomes According to SV Status and SPH
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n = 94 | |
---|---|
Age (years) | 62.2 ± 9.1 |
Sex (M:F) | 52:42 |
BMI (kg/m2) | 22.8 ± 3.1 |
Liver diseases | 6 (6.4%) |
CA 19-9 (U/mL) | 98 (15–416) |
Platelet count (103/uL) | 249 ± 87 |
Splenic volume (cc) | 156 ± 101 |
Neoadjuvant chemotherapy | 45 (47.9%) |
IMV insertion type | |
Type I | 8 (8.5%) |
Type II | 38 (40.4%) |
Type III | 48 (51.1%) |
Postoperative PV or SMV stricture | 26 (27.7%) |
Vascular resection method | |
Tangential resection | 29 (30.9%) |
Segmental resection | 65 (69.1%) |
Splenic vein status | |
Splenic vein ligation | 50 (53.2%) |
Splenic vein saving | 44 (46.8%) |
IMV ligation | 34 (36.2%) |
Operation time (min) | 487 ± 116 |
Blood loss (mL) | 888 ± 613 |
Complication (CDC ≥ III) | 12 (12.8%) |
POPF (≥Grade B) | 2 (2.1%) |
Ascites | 12 (12.8%) |
Thrombosis | 5 (5.3%) |
R1 resection | 17 (18.1%) |
T stage | |
0 | 6 (6.4%) |
1 | 30 (31.9%) |
2 | 54 (57.4%) |
3 | 4 (4.3%) |
N stage | |
0 | 43 (45.7%) |
1 | 39 (41.5%) |
2 | 12 (12.8%) |
TNM stage | |
0 | 6 (6.4%) |
I | 36 (38.3%) |
II | 40 (42.6%) |
III | 12 (12.8%) |
Adjuvant chemotherapy | 74 (78.7%) |
Variceal formation | 22 (23.4%) |
Variceal bleeding | 2 (2.1%) |
Median follow-up (months) | 25 (16–37) |
Univariate Analysis | Multivariate Analysis | ||||||
---|---|---|---|---|---|---|---|
OR | 95%CI | p Value | OR | 95%CI | p Value | ||
IMV insertion type | Type I | 0.93 | 0.35–2.51 | 0.931 | |||
Type II | 0.43 | 0.05–3.85 | 0.429 | ||||
Type III | (reference) | ||||||
IMV ligation | 4.25 | 1.55–11.63 | 0.005 | ||||
SV ligation | 4.29 | 1.54–11.91 | 0.005 | 4.56 | 1.53–13.00 | 0.006 | |
Postoperative PV or SMV stricture | 3.80 | 1.38–10.44 | 0.010 | 3.98 | 1.36–11.69 | 0.012 | |
Vascular resection method | SR | 6.00 | 1.30–27.71 | 0.022 | |||
TR | (reference) |
SV Saving (n = 36) | SV Ligation (n = 32) | p Value | |
---|---|---|---|
Age (years) | 62.5 ± 9.2 | 62.9 ± 9.0 | 0.866 |
Sex (M:F) | 20:16 | 14:18 | 0.466 |
BMI (kg/m2) | 23.4 ± 3.2 | 22.5 ± 2.3 | 0.191 |
Liver diseases | 5 (13.9%) | 1 (3.1%) | 0.257 |
CA 19-9 (U/mL) | 73 [10–391] | 86 [18–276] | 0.907 |
Neoadjuvant chemotherapy | 15 (41.7%) | 15 (46.9%) | 0.852 |
IMV insertion type | 0.600 | ||
Type I | 2 (5.6%) | 3 (9.4%) | |
Type II | 17 (47.2%) | 11 (34.4%) | |
Type III | 17 (47.2%) | 18 (56.3%) | |
IMV ligation | 0 (0.0%) | 23 (71.9%) | <0.001 |
Vascular resection type | <0.001 | ||
Tangential resection | 24 (66.7%) | 1 (3.1%) | |
Segmental resection | 12 (33.3%) | 31 (96.9%) | |
Operation time (min) | 453 ± 93 | 510 ± 117 | 0.028 |
Blood loss (mL) | 843 ± 645 | 978 ± 622 | 0.385 |
Complication (CDC≥III) | 5 (13.9%) | 5 (15.6%) | >0.999 |
POPF (≥Grade B) | 1 (2.8%) | 1 (3.1%) | >0.999 |
Ascites | 4 (11.1%) | 4 (12.5%) | >0.999 |
Thrombosis | 2 (5.6%) | 1 (3.1%) | >0.999 |
R1 resection | 7 (19.4%) | 6 (18.8%) | >0.999 |
T stage | 0.967 | ||
0 | 2 (5.6%) | 1 (3.1%) | |
1 | 12 (33.3%) | 11 (34.4%) | |
2 | 21 (58.3%) | 18 (56.3%) | |
3 | 1 (2.8%) | 2 (6.3%) | |
N stage | 0.514 | ||
0 | 14 (38.9%) | 13 (40.6%) | |
1 | 15 (41.7%) | 16 (50.0%) | |
2 | 7 (19.4%) | 3 (9.4%) | |
TNM stage | 0.655 | ||
0 | 2 (5.6%) | 1 (3.1%) | |
I | 12 (33.3%) | 12 (37.5%) | |
II | 15 (41.7%) | 16 (50.0%) | |
III | 7 (19.4%) | 3 (9.4%) | |
Adjuvant chemotherapy | 31 (86.1%) | 25 (78.1%) | 0.587 |
Variceal formation | 2 (5.6%) | 9 (28.1%) | 0.028 |
Variceal bleeding | 0 (0.0%) | 1 (3.1%) | 0.953 |
Parameters | SV Saving (n = 36) | SV Ligation (n = 32) | p Value | |
---|---|---|---|---|
Preop. | Splenic volume (cc) | 149 ± 71 | 150 ± 68 | 0.938 |
Platelet counts (103/uL) | 269 ± 96 | 227 ± 64 | 0.038 | |
Platelet count < 100K | 0 (0.0%) | 0 (0.0%) | 1.000 | |
Variceal score | 0.0 ± 0.0 | 0.2 ± 0.7 | 0.091 | |
6M | Splenic volume (cc) | 149 ± 78 | 213 ± 108 | 0.007 |
Splenic volume (ratio) | 1.02 ± 0.24 | 1.42 ± 0.35 | <0.001 | |
Platelet count (103/uL) | 227 ± 76 | 166 ± 54 | <0.001 | |
Platelet count (ratio) | 0.92 ± 0.37 | 0.76 ± 0.27 | 0.059 | |
Platelet count < 100K | 0 (0.0%) | 2 (6.3%) | 0.422 | |
Variceal score | 0.9 ± 1.2 | 3.5 ± 2.2 | <0.001 | |
12M | Splenic volume (cc) | 137 ± 61 | 218 ± 114 | 0.002 |
Splenic volume (ratio) | 1.04 ± 0.34 | 1.45 ± 0.34 | <0.001 | |
Platelet count (103/uL) | 205 ± 56 | 161 ± 56 | 0.005 | |
Platelet count < 100K | 1 (3.1%) | 5 (18.5%) | 0.129 | |
Platelet count (ratio) | 0.82 ± 0.32 | 0.79 ± 0.40 | 0.677 | |
Variceal score | 0.9 ± 1.3 | 3.5 ± 2.2 | <0.001 | |
24M | Splenic volume (cc) | 154 ± 160 | 250 ± 138 | 0.074 |
Splenic volume (ratio) | 1.04 ± 0.44 | 1.53 ± 0.43 | 0.003 | |
Platelet count (103/uL) | 184 ± 41 | 154 ± 54 | 0.086 | |
Platelet count < 100K | 0 (0.0.%) | 1 (6.3%) | 0.975 | |
Platelet count (ratio) | 0.66 ± 0.42 | 0.73 ± 0.31 | 0.583 | |
Variceal score | 1.4 ± 1.8 | 4.0 ± 3.4 | 0.009 |
Univariate Analysis | Multivariate Analysis | |||||||
---|---|---|---|---|---|---|---|---|
HR | 95%CI | p Value | HR | 95%CI | p Value | |||
DFS | Preop. CA 19-9 (log scale) | 1.00 | 0.78–1.26 | 0.989 | 1.02 | 0.81–1.30 | 0.845 | |
TNM stage | III | 4.94 | 1.59–7.35 | <0.001 | 4.15 | 2.15–8.00 | <0.001 | |
II | 3.42 | 2.74–8.2 | 0.002 | 3.09 | 1.32–7.23 | 0.009 | ||
I | (reference) | (reference) | ||||||
R1 resection | 1.24 | 0.74–2.10 | 0.420 | 1.35 | 0.67–2.68 | 0.396 | ||
Adjuvant chemotherapy | 1.40 | 0.76–2.59 | 0.264 | 0.91 | 0.46–1.82 | 0.792 | ||
Sinistral portal hypertension | 1.21 | 0.71–2.09 | 0.479 | 1.21 | 0.69–2.14 | 0.509 | ||
OS | Preop. CA 19-9 (log scale) | 1.15 | 0.85–1.55 | 0.371 | 1.20 | 0.89–1.62 | 0.233 | |
TNM stage | III | 4.45 | 2.42–8.19 | <0.001 | 3.32 | 1.53–7.21 | 0.002 | |
II | 3.47 | 1.52–7.91 | 0.003 | 2.92 | 0.69–7.05 | 0.180 | ||
I | (reference) | (reference) | ||||||
R1 resection | 1.27 | 0.66–2.43 | 0.479 | 1.18 | 0.63–2.21 | 0.609 | ||
Adjuvant chemotherapy | 1.31 | 0.61–2.82 | 0.495 | 0.88 | 0.38–2.03 | 0.756 | ||
Sinistral portal hypertension | 1.32 | 0.76–2.29 | 0.328 | 1.03 | 0.62–1.73 | 0.902 |
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Kim, S.H.; Kim, S.-S.; Hwang, H.K.; Lee, W.J.; Kang, C.M. Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer. Cancers 2022, 14, 4853. https://doi.org/10.3390/cancers14194853
Kim SH, Kim S-S, Hwang HK, Lee WJ, Kang CM. Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer. Cancers. 2022; 14(19):4853. https://doi.org/10.3390/cancers14194853
Chicago/Turabian StyleKim, Sung Hyun, Seung-Seob Kim, Ho Kyoung Hwang, Woo Jung Lee, and Chang Moo Kang. 2022. "Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer" Cancers 14, no. 19: 4853. https://doi.org/10.3390/cancers14194853
APA StyleKim, S. H., Kim, S. -S., Hwang, H. K., Lee, W. J., & Kang, C. M. (2022). Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer. Cancers, 14(19), 4853. https://doi.org/10.3390/cancers14194853