Is Pancreatic Head Cancer with Portal Venous Involvement Really Borderline Resectable? Appraisal of an Upfront Surgery Series.

Abstract

It remains controversial whether the degree of venous involvement really is associated with borderline resectability of pancreatic cancer. A single-center retrospective review of patients who underwent upfront pancreaticoduodenectomy for T3 pancreatic cancer without arterial involvement was performed. The patients were classified as having resectable tumors without venous contact (R group), resectable tumors with venous contact of 180° or less (R-PV group), and borderline resectable tumors with venous contact greater than 180° (BR-PV group). The unresectable group included those who had unresected tumors with paraaortic lymph node metastasis, positive peritoneal lavage cytology, or locally advanced disease. The overall survival and prognostic factors were analyzed. The study enrolled 299 resected patients, including 141 patients in the R group, 119 patients in the R-PV group, and 39 patients in the BR-PV group. The overall survival did not differ significantly between the R-PV group and the BR-PV group (median survival, 20.7 vs 18.6 months; P = 0.807). Among the 158 patients who had tumors with venous contact, only a tumor size of 50 mm or larger (P = 0.041) was an independent prognostic factor in a multivariate analysis, and the overall survival for the patients with both venous contact and tumor size 50 mm or larger was comparable with that for the unresectable group (P = 0.547). The degree of venous involvement may not be associated with the resectability of pancreatic head cancer, whereas tumors 50 mm in size or larger that develop venous invasion may be categorized as borderline resectable pancreatic cancers.