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Background <p>With better surgery and chemotherapeutic agents, borderline resectable or locally advanced pancreatobiliary tumours are being treated with curative intent. This study presents real-world evidence of porto-mesenteric vein resections (PVR) with pancreatectomy and generates predictive nomograms for postoperative mortality (POM) and major complications (MC).</p> Methods <p>A retrospective multicentre study, including 11 high-volume centres, evaluated patients undergoing PVR. Factors affecting 90-day POM and MC (Clavien-Dindo grades ≥ 3a) were assessed, and predictive nomograms were generated. Overall survival (OS) and disease-free survival (DFS) were estimated for patients with pancreatic ductal adenocarcinoma (PDAC). Cox regression analysis was performed to ascertain factors affecting OS and DFS.</p> Results <p>Among 389 patients, POM was 6.4%, and MCs were 32.6%. Charlson comorbidity index &gt; 4, preoperative biliary drainage, preoperative radiotherapy (PRT), segmental PVR, and additional organ resection (AOR) were predictive of POM. The independent predictors of MCs were American Society of Anesthesiologists status 3/4, PRT, and AOR. The generated model had an area under the curve (AUC) of 0.757, cutoff &gt; 1.79 to predict POM, and AUC of 0.669, cutoff &gt; 0.678 for MCs. In the 263 patients with PDAC, the median OS was 25.01 months (95% confidence interval [CI] 21.9–28.11), and DFS was 16.72 months (95% CI 14.56–18.89). Perineural invasion, segmental PVR, and margin positivity predicted worse survival, while completing multi-modality treatment was protective.</p> Conclusions <p>The POM and MCs of PVR with pancreatectomy were at par with the world standards. The generated predictive nomograms for POM and MC revealed a good predictive potential. In patients with PDAC, completion of multimodality treatment offers better long-term survival.</p>

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Real-World Evidence of Porto-Mesenteric Vein Resections with Pancreatectomy and the Development of Predictive Clinical Nomograms for Postoperative Outcomes—An Analysis of 389 Cases: The “Porto-Mesenteric Vein Resection-Indian MulticentrE” (PRIME) Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月5日

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  • Deeksha Kapoor,
  • Manish S. Bhandare,
  • Agam Sharma,
  • Raja Kalayarasan,
  • Monish Karunakaran,
  • Sree Kumar Balasubramanian,
  • Aishwarya Pal,
  • Nagaraj Palankar,
  • D. S. Darshanik,
  • Subhash Soni,
  • Sreenivas Reddy Biravely,
  • ArunKumar Namachivayam,
  • Rajneesh Kumar Singh,
  • Vaibhav Varshney,
  • Adarsh Chaudhary,
  • Sadiq Sikora,
  • Rajesh Gupta,
  • Sanjay Govil,
  • Pradeep Rebala,
  • Biju Pottakkat,
  • Hariharan Ramesh,
  • Vikram A. Chaudhari,
  • Shailesh V. Shrikhande

摘要

Background

With better surgery and chemotherapeutic agents, borderline resectable or locally advanced pancreatobiliary tumours are being treated with curative intent. This study presents real-world evidence of porto-mesenteric vein resections (PVR) with pancreatectomy and generates predictive nomograms for postoperative mortality (POM) and major complications (MC).

Methods

A retrospective multicentre study, including 11 high-volume centres, evaluated patients undergoing PVR. Factors affecting 90-day POM and MC (Clavien-Dindo grades ≥ 3a) were assessed, and predictive nomograms were generated. Overall survival (OS) and disease-free survival (DFS) were estimated for patients with pancreatic ductal adenocarcinoma (PDAC). Cox regression analysis was performed to ascertain factors affecting OS and DFS.

Results

Among 389 patients, POM was 6.4%, and MCs were 32.6%. Charlson comorbidity index > 4, preoperative biliary drainage, preoperative radiotherapy (PRT), segmental PVR, and additional organ resection (AOR) were predictive of POM. The independent predictors of MCs were American Society of Anesthesiologists status 3/4, PRT, and AOR. The generated model had an area under the curve (AUC) of 0.757, cutoff > 1.79 to predict POM, and AUC of 0.669, cutoff > 0.678 for MCs. In the 263 patients with PDAC, the median OS was 25.01 months (95% confidence interval [CI] 21.9–28.11), and DFS was 16.72 months (95% CI 14.56–18.89). Perineural invasion, segmental PVR, and margin positivity predicted worse survival, while completing multi-modality treatment was protective.

Conclusions

The POM and MCs of PVR with pancreatectomy were at par with the world standards. The generated predictive nomograms for POM and MC revealed a good predictive potential. In patients with PDAC, completion of multimodality treatment offers better long-term survival.