Background: Pancreatoduodenectomy with venous resection (PDVR) may be performed to achieve tumour clearance in patients with a pancreatic ductal adenocarcinoma (PDAC) with venous involvement. This study aimed to evaluate the impact of PDVR on PDAC outcomes.Methods: In total, 435 PDAC patients with either R0 status (n= 322) or R1 status within the superior mesenteric vein groove (n= 113) were extracted from the Recurrence After Whipple’s (RAW) study dataset. PDVR patients were matched in a 1:2 ratio with standard PD patients. Comparisons were then made between the two groups (surgical radicality and survival).Results: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%,p= 0.032) and R1 resection rates (17.9% vs. 42%,p< 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (p< 0.001 for sleeve andp= 0.034 for segmental resection), pT3 (p= 0.007), and pN1 stage (p= 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m),p= 0.023) and disease-free survival (DFS, 17 m vs. 24 m,p= 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m,p= 0.928) or DFS (R0: 18 m, R1: 17 m,p= 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (p= 0.034).Conclusions: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates.
背景：对于伴有静脉侵犯的胰腺导管腺癌（PDAC）患者，为达到肿瘤根治目的，可能实施胰十二指肠切除术联合静脉切除（PDVR）。本研究旨在评估PDVR对PDAC患者预后的影响。 方法：从"Whipple术后复发（RAW）"研究数据集中，共纳入435例PDAC患者，包括R0切除状态（n=322）及肠系膜上静脉沟R1切除状态（n=113）病例。将PDVR患者与标准PD患者按1:2比例进行匹配，比较两组在手术根治性和生存率方面的差异。 结果：81例PDVR患者与162例PD患者完成匹配。PDVR组的新辅助化疗使用率（5.7% vs. 13.6%，p=0.032）和R1切除率（17.9% vs. 42%，p<0.001）均显著更高。R1切除的危险因素包括静脉切除（袖状切除p<0.001，节段切除p=0.034）、pT3分期（p=0.007）和pN1分期（p=0.045）。PDVR组患者的中位总生存期（OS，21个月 vs. 30个月，p=0.023）和无病生存期（DFS，17个月 vs. 24个月，p=0.043）均显著缩短。在PDVR患者中，R状态对OS（R0：23个月，R1：21个月，p=0.928）和DFS（R0：18个月，R1：17个月，p=0.558）均无显著影响。无论R状态如何，PDVR组的全身复发率均更高（p=0.034）。 结论：无论R状态如何，PDVR组患者的总生存期更短，全身复发率更高。
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