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
{"title":"“门静脉-肠系膜静脉切除术-印度多中心”（PRIME）研究：389例病例分析：胰切除术后门静脉-肠系膜静脉切除术的真实证据和预测术后预后的临床nomography的发展。","authors":"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","doi":"10.1245/s10434-025-17702-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7410-7421"},"PeriodicalIF":3.5000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454574/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"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\",\"doi\":\"10.1245/s10434-025-17702-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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>\",\"PeriodicalId\":8229,\"journal\":{\"name\":\"Annals of Surgical Oncology\",\"volume\":\" \",\"pages\":\"7410-7421\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454574/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1245/s10434-025-17702-1\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1245/s10434-025-17702-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/5 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
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.
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.
期刊介绍：
The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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