Implications of an Isolated Positive Vascular Groove After Whipple for Pancreatic Adenocarcinoma: A Single Institution, Retrospective Analysis

Background and Objective: The vascular groove (VG) is no longer considered a resection margin but rather a surface of involvement. The clinical significance of an isolated VG+ remains debated. Therefore, this study evaluates the impact of isolated VG+, with or without vein resection, on overall survival (OS) and disease-free survival (DFS) following pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective analysis of 247 patients (2006-2019) was conducted. Patients were categorized into three groups: R0 resection (tumor > 1 mm from all margins, n = 168), VG+ without vein invasion (+VGnoVI, n = 66), and positive vein involvement with direct tumor invasion into the vein wall (+VGwithVI) (n = 13). Kaplan-Meier estimates assessed OS and DFS, while multivariable analyses identified recurrence and survival predictors. Results: +VGnoVI group showed higher rates of local recurrence (OR 2.68, p = 0.002) compared to the R0 group. However, no significant differences were observed in DFS (R0: 17 months; +VGnoVI: 18 months; +VGwithVI: 21 months, p = 0.68) or OS (R0: 27 months; +VGnoVI: 29 months; +VGwithVI: 30 months, p = 0.98) across groups. Conclusions: A positive vascular groove, whether isolated or associated with vein invasion, does not compromise OS or DFS compared to R0 resections.