Long-term outcomes of upfront pancreatectomy with venous resection for pancreatic cancer: a single-center, retrospective analysis

Background: Pancreatic cancer involving the portal vein and/or superior mesenteric vein (PV/SMV) necessitates pancreatectomy with venous resection (PVR). This study evaluated the long-term outcomes and associated factors in patients undergoing upfront PVR. Materials and methods: A retrospective, single-center cohort study included patients who underwent upfront PVR over five years. Survival outcomes and prognostic factors were assessed using Kaplan–Meier survival curves and multivariable regression analyses. Results: Of 404 patients who underwent upfront PVR, the 30-day mortality rate was 1.2%, and the 90-day mortality rate was 3.7%. The median overall survival (OS) was 19.8 months (95% CI: 17.5-22.9), with 1-, 2-, and 3-year OS rates of 71.4%, 40.8%, and 23.2%, respectively. Multivariate analysis identified older age (>65 years), elevated preoperative CA19-9 levels (>200 UI/mL), poor tumor differentiation, and lack of adjuvant chemotherapy as predictors of decreased OS. Notably, radiological or pathological evidence of venous invasion was an independent predictor of poor survival. Importantly, postoperative adjuvant treatment significantly improved OS. Conclusions and relevance: Venous invasion is an independent prognostic factor for poor survival in pancreatic cancer patients undergoing upfront PVR, and adjuvant chemotherapy significantly enhances survival in these cases.