VENous Invasion in PANcreatic Cancer

Invasion of the portal vein (PV) or superior mesenteric vein (SMV) in pancreatic cancer is not considered a contra-indication for resection as stated by the International Study Group of Pancreatic Surgery (ISGPS) in 2014.One of the main challenges for a pancreatic surgeon when confronted with possible tumor invasion of the PV-SMV is distinguishing tumor from peritumoral inflammation and fibrosis. Futile venous resection (no invasion of the resected PV-SMV) puts the patients at unnecessary risk for complications. Some studies, with different results, have been conducted regarding the prognostic value of depth of tumor invasion in the resected PV-SMV for overall survival. No studies reported on the prognostic value of depth of tumor invasion for time to recurrence. The aim of this study was to evaluate the number of justified/futile venous resections and correlation between venous resections and recurrence and overall survival patterns.

We hypothesize that approximately 2/3 of venous resections are justified by tumor invasion. Future studies on (intraoperative) imaging might help increase the number of justified venous resection. The prognostic value of depth of invasion will help surgeons in counselling patients and possibly apply personalized follow-up.

Nov 18 - Jan 19: optimize protocol
Feb 19 - May 19: data collection
June 19: first analysis
July 19: first draft of manuscript
Aug 19: final draft of manuscript
Sept 19: submission