Prognosis and feasibility of en-bloc vascular resection in stage II pancreatic adenocarcinoma

Table 1 Clinicopathological features of patients with stage II pancreatic adenocarcinoma (mean ± SD) n (%)

Parameters	With vascular resection (n = 12)	Without vascular resection (n = 75)	P value
Age (yr)	62.9 ± 11.0	62.9 ± 9.8	0.994
Gender			0.745
Male	7 (58.3)	50 (66.7)
Female	5 (41.7)	25 (33.3)
Symptoms
Jaundice	6 (50.0)	55 (73.3)	0.171
Abdominal pain	6 (50.0)	35 (46.7)	0.830
Body weight loss	6 (50.0)	31 (41.3)	0.573
Anorexia	3 (25.0)	17 (22.7)	1.000
Signs
Anemic	4 (33.3)	38 (50.7)	0.265
Icterus	6 (50.0)	54 (72.0)	0.178
Abdominal tenderness	3 (25.0)	15 (20.0)	0.707
Albumin (g/dL)	3.9 ± 0.6	3.7 ± 0.5	0.205
Total bilirubin (mg/dL)	6.8 ± 7.0	8.9 ± 7.1	0.333
Pre-op biliary drainage			0.573
Yes	6 (50.0)	44 (58.7)
No	6 (50.0)	31 (41.3)
CEA (ng/mL)			1.000
≤ 5	5 (62.5)	36 (62.1)
> 5	3 (37.5)	22 (37.9)
CA19-9 (U/mL)			0.411
≤ 37	3 (33.3)	13 (21.0)
> 37	6 (66.7)	49 (79.0)
Operation time (min)	473.9 ± 185.2	461.6 ± 110.4	0.826
Blood transfusion (mL)	396 ± 588	304 ± 590	0.618
Tumor size (cm)	3.6 ± 1.6	3.3 ± 1.4	0.526
Lymph node metastases			0.097
Yes	8 (66.7)	65 (86.7)
No	4 (33.3)	10 (13.3)
Curability			0.015
Yes	12 (100.0)	48 (64.0)
No	0 (0.0)	27 (36.0)
Postoperative chemotherapy			0.436
Yes	8 (66.7)	41 (54.7)
No	4 (33.3)	34 (45.3)

CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen.

Table 2 Morbidity and mortality in patients with stage II pancreatic adenocarcinoma n (%)

Parameters	With vascular resection (n = 12)	Without vascular resection (n = 75)
Morbidity	6/12 (50.0)	30/75 (40.0)
Pancreatic leakage	2 (16.7)	9 (12.0)
Pancreatic fistula	0 (0.0)	8 (10.7)
Gastrointestinal bleeding	1 (8.3)	6 (8.0)
Pleural effusion	2 (8.3)	4 (5.3)
Delayed gastric emptying	1 (8.3)	3 (4.0)
Wound infection	0 (0.0)	4 (4.0)
Intra-abdominal abscess	0 (0.0)	4 (5.3)
Bile leakage	1 (8.3)	3 (4.0)
Sepsis	0 (0.0)	3 (4.0)
Intra-abdominal bleeding	1 (8.3)	2 (2.7)
Mortality	0 (0.0)	2 (2.7)

Table 3 Univariate analyses of predictive factors for survival of patients with stage II adenocarcinoma of the pancreas after PD or PPPD, with or without vascular resection

Parameters	Median (mo)	95% CI of median	3-yr survival (%)	P value
Age (yr)				0.852
≤ 70 (n = 62)	11.51	7.78-15.25	12.0
> 70 (n = 23)	9.40	9.15-9.65	16.3
Sex				0.191
Male (n = 55)	9.76	7.61-11.91	9.6
Female (n = 30)	14.01	3.20-24.82	19.4
Albumin (g/dL)				0.107
≤ 3.5 (n = 21)	7.40	3.86-10.94	12.7
> 3.5 (n = 47)	11.67	5.96-17.38	12.8
Total bilirubin (mg/dL)				0.008
≤ 2 (n = 19)	17.39	15.23-19.55	30.7
> 2 (n = 65)	9.40	7.66-11.14	3.5
Serum CA 19-9 (U/L)				0.167
≤ 37 (n = 16)	16.11	1.47-30.75	25.0
> 37 (n = 54)	11.51	8.17-14.85	12.3
Serum CEA (ng/mL)				0.455
≤ 5 (n = 40)	16.08	10.78-21.38	13.4
> 5 (n = 24)	7.82	5.18-10.46.	16.7
Blood transfusion				0.491
Yes (n = 47)	10.88	7.17-14.59	14.9
No (n = 38)	9.24	5.59-12.89	9.8
Tumor size (cm)
≤ 3 (n = 43)	13.97	10.77-17.18	13.3	0.508
> 3 (n = 41)	9.27	8.82-9.72	12.5
Nodal metastases				0.557
Yes (n = 71)	9.76	7.69-11.83	13.6
No (n = 14)	12.16	0.00-28.36	8.3
Pre-op biliary drainage				0.262
Yes (n = 49)	9.24	7.80-10.68	12.0
No (n = 36)	13.97	9.44-18.50	14.3
PV/SMV resection				0.994
Yes (n = 12)	9.27	0.00-19.54	16.7
No (n = 73)	10.36	7.87-12.86	12.2
Resection margin1				0.071
Negative (n = 58)	11.51	6.46-16.56	16.1
Positive (n = 27)	9.27	7.46-11.08	5.1
Differentiation				0.016
Well (n = 25)	20.98	9.02-32.94	24.0
Moderately (n = 45)	8.81	7.81-9.81	8.8
Poorly (n = 15)	10.49	7.01-13.97	6.7
Adjuvant chemotherapy				0.008
Yes (n = 53)	12.99	10.44-12.74	18.8
No (n = 32)	7.96	5.74-10.19	3.2

Two cases of mortality were not included in survival analysis.

¹Resection margin was negative in all 12 patients who underwent vascular resection.

Table 4 Multivariate analysis in stage II pancreatic adenocarcinoma of the head and uncinate process

Parameters	Hazard ratio (95% CI)	P value
Bilirubin (mg/dL)
≤ 2/> 2	2.024 (1.613-3.774)	0.026
Differentiation		0.005
Moderately/well	2.412 (1.379-4.217)	0.002
Poorly/well	2.091 (1.034-4.225)	0.040
Adjuvant chemotherapy
No/yes	2.068 (1.270-3.366)	0.003
PV/SMV resection
Yes/no		0.591