• Thomas F Stoop, Adrienne Molnár, Leonard W F Seelen, Toshitaka Sugawara, Jacobien C M Scheepens, Mahsoem Ali, Ammar A Javed, Asif Halimi, Atsushi Oba, Bas Groot Koerkamp, Bodil Andersson, Caroline Williamsson, Christopher L Wolfgang, Daisuke Ban, Ernesto Sparrelid, Freek Daams, Geert Kazemier, Hjalmar C van Santvoort, Ingmar F Rompen, I Quintus Molenaar, Joseph R Habib, Lysanne P M Beuk, Niek J Geerdink, Roeland F de Wilde, Olivier R Busch, Oskar Swartling, Paulina Bereza-Carlson, Poya Ghorbani, Reeve L Kruize, Richard D Schulick, FrancoSalvador RodriguezSR0000-0001-9786-3651Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Tatsunori Miyata, Oskar Franklin, Yosuke Inoue, Marc G Besselink, Marco Del Chiaro, and International Collaborative Group on Locally Advanced Pancreatic Cancer.
• Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
• Ann. Surg. 2025 Jan 22.

ObjectiveTo investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcome in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement.Summary Background DataCurrent comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability.MethodsInternational retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180° PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders.ResultsOverall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95%CI, 17-32) after tangential and 23% (95%CI, 17-30) after segmental PVR (P=0.98). After adjusting for confounders, PVR type was not associated with OS (HR=0.94 [95%CI, 0.69-1.30]), RFS (HR=0.94 [95% CI, 0.69 to 1.28), and locoregional recurrence (OR=0.76 [95%CI, 0.40-1.46]).ConclusionsIn patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180° PMV involvement, the type of PVR (i.e., tangential vs. segmental) was not associated with differences in surgical and oncological outcome. This suggest that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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