Vascular resection for pancreas cancer: Ten-year real-world experience from a single high-volume center.
Bibliographic record
Abstract
638 Background: In pancreatic ductal adenocarcinoma (PDAC), to identify prognostic factors for surgically treated patients, including vascular resections. Methods: Retrospective review (2011 – 2023) of pathologically proven PDAC treated with curative-intent surgery (n = 715) at a high-volume cancer center. We tested associations between clinicopathological and radiological data, perioperative therapy, time to recurrence (TTR) and overall survival (OS). Results: Demographic and clinicopathological variables were comparable to published surgical cohorts. Initial NCCN radiological staging was 533 (74.5%) resectable, 98 (13.7%) borderline, and 84 (11.7%) locally advanced PDAC. There were 467(65.3%) pancreaticoduodenectomies, 104 (14.5%) distal pancreatectomies, 31 (4.3%) total pancreatectomies and 112 (15.7%) aborted procedures, mostly due to metastatic disease (82.1%). Of the 603 resected cases, 351 (58.2%) were non-vascular resections (NVR), 181 (30.0%) venous-only resections (VR), and 70 (11.8%) were arterial ± venous resections (AR). Median length of stay was 8 days, ICU admission rate was 6.1% (n = 37), readmissions occurred in 114 (18.9%) cases and reoperations in 47 (7.8%) cases. The 90-day mortality rate was 3.2% (n = 19) and the 5-year OS was 20.7%. Perioperative chemotherapy was given to 258 (78.4%) NVR, 129 (75.9%) VR and 60 (93.8%) AR. Perioperative chemoradiation was given to 20 (6.8%) NVR, 34 (21.0%) VR and 43 (66.1%) AR. Median TTR and OS did not significantly differ by initial NCCN staging or type of pancreas resection. Median TTR and OS were significantly shorter for VR (14.5 and 22.7 months) compared to NVR (18.6 and 30.5 months, p<0.001) and AR (20.6 months, p = 0.004 and 30.9 months, p = 0.017). Patients who received chemotherapy or chemoradiation had significantly longer TTR (20.1 vs. 10.2 months, p<0.001 and 25.3 vs. 16.4 months, p<0.001) and OS (31.5 vs. 17.2 months, p<0.001 and 35.5 vs. 27.5 months, p=0.030) compared to patients not receiving any therapy. In multivariate analysis, when controlling for perioperative therapy and usual clinicopathological factors, vascular resection was not associated with TTR and OS. Perioperative chemotherapy, chemoradiation, pathological N0 status, and absence of perineural invasion were significant independent predictors of longer TTR and OS. For VR specifically, patients who received chemotherapy and chemoradiation had significantly longer median TTR and OS (41.9 and 35.3 months) compared to patients receiving chemotherapy alone (14.3 and 24.6 months, p<0.001 and p=0.017) or receiving no perioperative therapy (9.5 and 12.8 months, p <0.001 and p = 0.004). Conclusions: In this cohort of patients with PDAC treated with surgical resection at a high-volume cancer center, vascular resection was not associated with oncological outcomes when controlling for administration of perioperative therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".