J Gastrointest Surg. 2026 Apr 3:102412. doi: 10.1016/j.gassur.2026.102412. Online ahead of print.
ABSTRACT
INTRODUCTION: Multivisceral resection (MVR) in pancreatic ductal adenocarcinoma (PDAC) involves en bloc resection of adjacent organs due to direct invasion. Despite its clinical significance, adjacent organ invasion is not included as a determinant in AJCC staging or NCCN resectability criteria. This study aimed to evaluate the safety and efficacy of MVR compared to standard resection.
METHODS: We analyzed 1,222 patients who underwent surgery for PDAC between 2009 and 2019 at a tertiary institution. Patients with stage IV disease, recurrent operations, incomplete data, or MVR performed for double primary malignancy were excluded. Propensity Score Matching (PSM) was conducted at a 1:2 ratio, matching for operation type and AJCC T/N stages. Short- and long-term outcomes were compared between two groups.
RESULTS: Before PSM, 42 MVR cases and 1,099 standard resections demonstrated similar postoperative hospital stay lengths (11.4 vs. 12.6 days, p=0.094), major complications (23.8% vs. 19.0%, p=0.566), and clinically relevant postoperative pancreatic fistula (11.9% vs. 6.6%, p=0.310). However, MVR showed poorer long-term outcomes including 2-year overall survival rate (2YSR) (33.3% vs. 49.9%, p=0.006), 2-year disease-free survival rate (2YDFSR) (11.3% vs. 25.9%, p=0.018), and 2-year local recurrence rate (2YLRR) (41.3% vs. 30.9%, p=0.319). After PSM, both groups maintained similar short-term outcomes and showed no statistical difference in 2YSR (p=0.143), 2YDFSR (p=0.279), and 2YLRR (p=0.362).
CONCLUSION: MVR demonstrates comparable short- and long-term outcomes to standard resection and should be considered for selected patients with suspected organ invasion. These findings reinforce current staging and resectability criteria and support surgical decision-making for PDAC.
PMID:41936997 | DOI:10.1016/j.gassur.2026.102412
