Skip to main content

Advertisement

SpringerLink
Log in

Pathological and Radiological Splenic Vein Involvement are Predictors of Poor Prognosis and Early Liver Metastasis After Surgery in Patients with Pancreatic Adenocarcinoma of the Body and Tail

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognostic impact of pancreatic ductal adenocarcinoma (PDAC) invasion to the splenic vessel is controversial.

Objective

The aim of this study was to assess the clinical value of pathological and radiological splenic vessel invasion in PDACs of the body and tail.

Methods

Medical records of patients with resectable PDAC of the body and tail who underwent distal pancreatectomy between 2003 and 2016 at the Kobe University Hospital were retrospectively analyzed.

Results

Overall, 68 patients (29 female and 39 male patients) were enrolled. Pathologically determined splenic vein invasion (p-SV) and splenic artery invasion (p-SA) were identified in 21 (30.9%) and 5 (7.4%) patients, respectively. The p-SV (but not p-SA) was an independent prognostic factor in multivariate analysis (p = 0.009). On analysis of recurrence patterns, patients with PDAC positive for p-SV were at a higher risk for liver metastasis (p = 0.022); however, the associations were not significant for other recurrence patterns. Liver metastasis occurred earlier in patients who were positive for p-SV (p = 0.015). Preoperative computed tomography effectively diagnosed pathological vessel invasion (SV: sensitivity, 95.2%, specificity, 72.3%; SA: sensitivity, 100%, specificity, 84.1%). Radiological SV invasion remained significant in multivariate analysis regarding postoperative survival (p = 0.007), and was also associated with early liver metastases (p = 0.008).

Conclusions

Pathological/radiological SV invasion were independent adverse prognostic factors associated with early liver metastasis in patients with PDAC of the body/tail. Assessment of these findings may be useful in determining optimal therapeutic options in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992;326:455–65.

    Article  CAS  PubMed  Google Scholar 

  2. Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985 to 1995, using the National Cancer Database. J Am Coll Surg. 1999;189:1–7.

    Article  CAS  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network (2017). NCCN clinical practice guidelines in oncology (NCCN Guidelines). Pancreatic adenocarcinoma. Version 1. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 10 Jan 2017.

  4. Murakami Y, Satoi S, Sho M, et al. National comprehensive cancer network resectability status for pancreatic carcinoma predicts overall survival. World J Surg. 2015;39:2306–14.

    Article  PubMed  Google Scholar 

  5. Wang F, Gill AJ, Neale M et al. Adverse tumor biology associated with mesenterico-portal vein resection influences survival in patients with pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2014;21:1937–47.

    Article  CAS  PubMed  Google Scholar 

  6. Yamada S, Fujii T, Sugimoto H, Nomoto S, Takeda S, Kodera Y, Nakao A. Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. Pancreas. 2013;42:1004–10.

    Article  PubMed  Google Scholar 

  7. Mierke F, Hempel S, Distler M, Aust DE, Saeger HD, Weitz J, et al. Impact of portal vein involvement from pancreatic cancer on metastatic pattern after surgical resection. Ann Surg Oncol. 2016;23:730–6.

    Article  PubMed  Google Scholar 

  8. Cloyd JM, Katz MH, Prakash L et al. Preoperative therapy and pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a 25-year single-institution experience. J Gastrointest Surg. 2017;21:164–74.

    Article  PubMed  Google Scholar 

  9. Barugola G, Partelli S, Crippa S, Capelli P, D’Onofrio M, Pederzoli P, et al. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg. 2012;203:132–9.

    Article  PubMed  Google Scholar 

  10. Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261:12–17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery. 2006;139:288–95.

    Article  PubMed  Google Scholar 

  12. Kanda M, Fujii T, Sahin TT et al. Invasion of the splenic artery is a crucial prognostic factor in carcinoma of the body and tail of the pancreas. Ann Surg. 2010;251:483–7.

    Article  PubMed  Google Scholar 

  13. Partelli S, Crippa S, Barugola G et al. Splenic artery invasion in pancreatic adenocarcinoma of the body and tail: a novel prognostic parameter for patient selection. Ann Surg Oncol. 2011;18:3608–14.

    Article  PubMed  Google Scholar 

  14. Fukami Y, Kaneoka Y, Maeda A, Takayama Y, Onoe S. Prognostic impact of splenic artery invasion for pancreatic cancer of the body and tail. Int J Surg. 2016;35:64–8.

    Article  PubMed  Google Scholar 

  15. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2009.

    Google Scholar 

  16. Bissolati M, Sandri MT, Burtulo G, Zorzino L, Balzano G, Braga M. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer. Tumour Biol. 2015;36:991–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Takuya Mizumoto, Hirochika Toyama, Sadaki Asari, Sachio Terai, Hideyo Mukubo, Hironori Yamashita, Sachiyo Shirakawa, Yoshihide Nanno, Yuki Ueda, Keitaro Sofue, Motofumi Tanaka, Masahiro Kido, Tetsuo Ajiki, and Takumi Fukumoto have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Takuya Mizumoto MD, Hirochika Toyama MD, PhD, Sadaki Asari MD, PhD, Sachio Terai MD, PhD, Hideyo Mukubo MD, PhD, Hironori Yamashita MD, PhD, Sachiyo Shirakawa MD, PhD, Yoshihide Nanno MD, PhD, Yuki Ueda MD, Motofumi Tanaka MD, PhD, Masahiro Kido MD, PhD, Tetsuo Ajiki MD, PhD & Takumi Fukumoto MD, PhD

  2. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Keitaro Sofue MD, PhD

Authors
  1. Takuya Mizumoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirochika Toyama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sadaki Asari MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sachio Terai MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hideyo Mukubo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hironori Yamashita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sachiyo Shirakawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshihide Nanno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuki Ueda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keitaro Sofue MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Motofumi Tanaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masahiro Kido MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tetsuo Ajiki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takumi Fukumoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirochika Toyama MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mizumoto, T., Toyama, H., Asari, S. et al. Pathological and Radiological Splenic Vein Involvement are Predictors of Poor Prognosis and Early Liver Metastasis After Surgery in Patients with Pancreatic Adenocarcinoma of the Body and Tail. Ann Surg Oncol 25, 638–646 (2018). https://doi.org/10.1245/s10434-017-6274-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-6274-8

Keywords

Search

Navigation