• Yuichi Nagakawa, Jin-Young Jang, Manabu Kawai, Song Cheol Kim, Yosuke Inoue, Ryusei Matsuyama, Jin Seok Heo, Masayuki Honda, Teiichi Sugiura, Masayuki Ohtsuka, Shugo Mizuno, Wooil Kwon, Kenichiro Uemura, Ho-Seong Han, Motokazu Sugimoto, Keiichi Okano, Masafumi Nakamura, Keita Wada, Yusuke Kumamoto, Hiroaki Osakae, Akihiko Tsuchida, Yoo-Seok Yoon, Joon Seong Park, Hiroki Yamaue, and Itaru Endo.
• Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
• Ann. Surg. 2023 May 1; 277 (5): e1081e1088e1081-e1088.

ObjectiveThe aim of this study was to investigate the safety and survival benefits of portal vein and/or superior mesenteric vein (PV/SMV) resection with jejunal vein resection (JVR) for pancreatic ductal adenocarcinoma (PDAC).Summary Background DataFew studies have shown the surgical outcome and survival of pancreatic resection with JVR, and treatment strategies for patients with PDAC suspected of jejunal vein (JV) infiltration remain unclear.MethodsIn total, 1260 patients who underwent pancreatectomy with PV/ SMV resection between 2013 and 2016 at 50 facilities were included; treatment outcomes were compared between the PV/SMV group (PV/ SMV resection without JVR; n = 824), PV/SMV-J1 V group (PV/SMV resection with first jejunal vein resection; n = 394), and PV/SMV-J2,3 V group (PV/SMV resection with second jejunal vein or later branch resection; n = 42).ResultsPostoperative complications and mortality did not differ between the three groups. The postoperative complication rate associated with PV/ SMV reconstruction was 11.9% in PV/SMV group, 8.6% in PV/SMV-J1 V group, and 7.1% in PV/SMV-J2,3V group; there were no significant differences among the three groups. Overall survival did not differ between PV/SMV and PV/SMV-J1 V groups (median survival; 29.2 vs 30.9 months, P = 0.60). Although PV/SMV-J2,3 V group had significantly shorter survival than PV/SMV group who underwent upfront surgery ( P = 0.05), no significant differences in overall survival of patients who received preoperative therapy. Multivariate survival analysis revealed that adjuvant therapy and R0 resection were independent prognostic factors in all groups.ConclusionPV/SMV resection with JVR can be safely performed and may provide satisfactory overall survival with the pre-and postoperative adjuvant therapy.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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