VEnous ReSection during pancreatoduodenectomy

Radical tumor resection followed by adjuvant chemotherapy is the current standard treatment of
patients with resectable pancreatic cancer.1 The pre- and intra-operative assessment of portal vein
(PV) or superior mesenteric vein (SMV) involvement is particular important since this resection
margin is among the most affected.2 PV-SMV resection is indicated if required to aim for a radical
resection, as stated by the International Study Group of Pancreatic Surgery.3 A recent meta-analysis
showed increased postoperative mortality and worse survival after PV-SMV resection.4 The included
studies were considered as low evidence and were quite heterogeneous (e.g. low -and high-volume
hospitals, time-period: 2006-2014). The short- and long-term outcomes of PV-SMV resection in the
Netherlands have not been reported, which will become more important in the near future due to
the increasing use of neoadjuvant therapy in borderline and locally advanced pancreatic cancer.
The evaluation of tumor extension and PV-SMV involvement on preoperative imaging is also
becoming a clinical challenge since the growing use of neoadjuvant therapy.5-7 Moreover, an
absence of tumor invasion/approximation is reported in around half of the PV-SMV resections,
indicating the difficulties of pre- and intra-operative assessment of PV-SMV involvement.8-10
Recent efforts are focussing on utilizing intra-operative imaging modalities for improved tumor
extension evaluation (e.g. intra-operative ultrasound, upcoming UltraPanc study; tumor-specific
near-infrared fluorescence). The focus of this project is to investigate the current state of art of PVSMV
involvement assessment and subsequent resection in relation to the pathological and surgical
outcomes in the Netherlands. This platform provide an opportunity for a multidisciplinary approach
to PV-SMV resections during pancreatoduodenectomy, hereby ultimately improving the clinical
outcomes of patients with pancreatic cancer. Our aim is to investigate 1) discrepancies between pre- and intra-operative suspected PV-SMV involvement
and histopathology findings in patients undergoing pancreatoduodenectomy with(out) PV-SMV resection for pancreatic
adenocarcinoma and 2) short- and long-term outcomes after PV-SMV resection

not applicable

Venous resection