A monocentric, retrospective study of 645 patients who underwent radical surgery for pancreatic head carcinoma was conducted. The primary goal was to compare outcomes between pancreatoduodenectomies with and without venous resection.

The patients were stratified into two groups: 121 patients (18.8 %) with venous resection (VR) and 524 (81.2 %) with standard pancreaticoduodenal resections (SPDR). A p-value cut-off of 0.05 was used to determine significance. Effect size (r) was analyzed to determine the clinical relevance of survival, and multivariable analysis was used to define the risk factors.

Overall survival between the two primary groups was significant in favor of the SPDR but with minor clinical relevance according to the effect size (52.6 vs. 23.2 months, p<0.0001, r=0.42). The VR group showed better long-term outcomes than the palliative procedures (8.4 months, p<0.0001). VR had higher mortality than SPDR at 30 days (p=0.005) and 90 days (p=0.0002). No significance was found for 30-day mortality after 2014 (p=0.083). Major complications were similar (VR-16.8% vs. SPDR-15.7%, p=0.771).

Compared with standard resections, venous resection demonstrated worse long-term outcomes with equivalent short-term results and better survival than palliative procedures. In experienced hands and high-volume centers, venous resection is a safe and feasible intervention.