XXXX with @entity1211 : Is Up-Front Synchronous Portal-Superior Mesenteric Vein Resection Still Justified? A Survey of the Association Fran  aise de Chirurgie.

@entity5 @entity1 @entity788 @entity1211
BACKGROUND: Venous resection (VR) during pancreatectomy has been reported to neither increase mortality nor morbidity and to provide similar survival outcomes in same stage @entity5 . However, controversy remains regarding the indications for up-front surgery according to the degree of @entity1211 . METHODS: From 2004 to 2009, 1,399 @entity1 included in a French multicenter survey underwent pancreaticoduodenectomy or total pancreatectomy for @entity788 , either without VR (997 standard resections [SR]) or with VR (402 @entity1 ; 29  %). Postoperative and long-term outcomes were compared in both groups. RESULTS: VR was associated with the following factors: larger @entity5 (p  <  0.001), poorly differentiated @entity5 (p  =  0.004), higher numbers of positive lymph nodes (p  =  0.042), and positive resection margins (R1; p  <  0.001). Overall, VR increased neither postoperative morbidity nor postoperative mortality (5 vs. 3  % in SR @entity1 ; p  =  0.16). The median and 3-year survival rates in VR @entity1 versus SR @entity1 were 21  months and 31  % vs. 29  months and 44  %, respectively (p  =  0.0002). In the entire cohort, multivariate analysis identified VR as a significant poor prognostic factor for long-term survival (hazard ratio [HR] 1.75, 95  % confidence interval [CI] 1.28-2.40; p  =  0.0005). In the VR @entity1 , lymph node ratio, whatever the cutoff (<0.3: p  =  0.093; >= 0.3: p  =  0.0098), R1 resection (p  =  0.010), and segmental resection (p  =  0.016) were independent risk factors; neoadjuvant treatment (HR 0.52, 95  % CI 0.29-0.94; p  =  0.031) and adjuvant treatment (HR 0.55, 95  % CI 0.35-0.85; p  =  0.006) were significantly associated with improved long-term survival. CONCLUSIONS: Long-term survival after pancreatectomy was significantly altered when up-front VR was performed. Neoadjuvant treatment may be a better strategy than up-front resection in @entity1 with preoperative suspicion of @entity1211 .
