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• W2588627851 abstract "Portal vein thrombosis (PVT) and superior mesenteric vein thrombosis (SMVT) are associated with significant morbidity; however, there are limited data on risk factors for and outcomes of PVT/SMVT following neoadjuvant treatment for pancreatic adenocarcinoma (PDAC). We identified 108 patients with borderline resectable or locally advanced PDAC treated at our institution with neoadjuvant therapy followed by exploratory laparotomy between 2009 and 2014. All received neoadjuvant chemoradiation therapy (median dose 50.4Gy, range 25 – 58.8Gy), and 94 received neoadjuvant chemotherapy. 62 underwent surgical resection (49 pancreaticoduodenectomy, 13 distal/ completion pancreatectomy) of whom 26 received intraoperative radiation therapy (IORT) (median dose 10Gy, range 8-13). Of 46 patients who underwent exploratory laparotomy alone, 33 received IORT (median dose 16Gy, range 15-18) while 13 were not IORT candidates due to metastases or local disease extent. Clinical factors for PVT/SMVT were evaluated using the Fisher exact test/ Cox regression. Median follow-up was 18.4 months. 23 patients developed PVT/SMVT. Local recurrence (LR) was significantly associated with PVT/SMVT (p=0.045), as the majority (n=12, 52.2%) developed PVT/SMVT in the setting of recurrent or progressive local disease. Median time to PVT/SMVT was 7.4 months for patients with LR versus 5 months for those without LR. There was a trend towards increased risk of PVT/SMVT in patients who received IORT (p=0.06) or with long-standing diabetes (p=0.06). Vascular grafts were significantly associated with PVT/SMVT (p=0.002). On multivariate analysis, LR (AHR = 3.3, 95% CI = 1.3 – 8.2, p=0.011), vascular grafts (AHR = 18.2, 95% CI = 4.1 – 80.2, p=0.001), and IORT (AHR 4.5, 95% CI = 1.3 – 15.1, p=0.015) were significant predictors for PVT/SMVT. Management was challenging, particularly for patients without LR. 8 developed ascites requiring paracenteses and 5 required interventions including venous stents (n=4), drainage catheter (n=3), peritoneo venous shunt (n=2), TIPS (n=1) or thrombectomy (n=1). 10 of 12 patients with PVT/SMVT with LR have died, with median overall survival (OS) of 1.3 months after diagnosis of PVT/SMVT. 6 of 11 with PVT/SMVT without LR have died, with median OS of 10.4 months after PVT/SMVT. About 20% patients who undergo neoadjuvant chemoradiation for PDAC develop PVT/SMVT a median of 7 months following surgery. This is significantly associated with use of vascular grafts, LR, and IORT, and to a lesser degree with long-standing diabetes. When PVT/SMVT occurs in the setting of LR, survival is very poor, and when no LR is seen, it is associated with significant morbidity." @default.
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• W2588627851 date "2015-11-01" @default.
• W2588627851 modified "2023-09-22" @default.
• W2588627851 title "Clinical Predictors and Outcomes of Superior Mesenteric Vein or Portal Vein Thrombosis in the Setting of Neoadjuvant Therapy for Borderline Resectable or Locally Advanced Pancreatic Adenocarcinoma" @default.
• W2588627851 doi "https://doi.org/10.1016/j.ijrobp.2015.07.906" @default.
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