Portal Vein Thrombosis Associated With Unresectable Pancreatic Cancers : a Prospective Multicentric Cohort Study
Portal Vein Thrombosis Associated With Unresectable Pancreatic Cancers : a Prospective Multicentric Cohort Study
Little is known concerning the management of portal vein thrombosis (PVT) in digestive
 cancers other than hepato-cellular carcinoma (HCC). The use of anticoagulant treatment (ACT),
 screening of oesophageal varices (OV) and oesogatric varices (OGV), and primary prophylaxis
 of OV (treatment with beta-blocker (BB) and / or OV ligation) if necessary are not clearly
 defined. The autopsy series by Ogren et al. (World J Gastroenterol. 2006) found an incidence
 of PVT in cancer patients of 1%, with 44% of digestive cancers other than HCC as a common
 etiology, mostly pancreatic adenocarcinoma (42%).

 We reported a retrospective French study that included 118 patients with digestive cancers
 other than HCC, including 50% locally advanced or metastatic pancreatic adenocarcinoma, with
 PVT complications. A total of 38% of patients had radiological signs of portal hypertension
 (PHT) and 51% had ACT. Only 1% of patients were screened for VO (n = 7). In addition, 19% (n
 = 22) presented gastrointestinal bleeding. Among the causes of death, 17% (n = 12) were due
 to gastrointestinal bleeding. Overall survival (OS) was statistically associated with a
 metastatic disease (HR = 2.83 [95% CI 1.47-5.43], p <0.01) and gastrointestinal bleeding (HR
 = 1.68 [95% CI 1.01-2.78], p = 0.04).

 Bleeding complications from PHT are not uncommon in patients with digestive cancer,
 especially in patients with pancreatic cancer with PVT; but above all they can be responsible
 for death. No data existed before our first study (Regnault et al. Dig Liv Dis 2018).
 However, these data must be validated in a prospective multicentric study with standardized
 follow-up. In order to obtain precise and homogeneous data, we have chosen to target
 pancreatic cancers as these tumors are the most common causes of PVT.
Inclusion Criteria:

 -  Pancreatic adenocarcinoma proven histologically or cytologically in favor of
 pancreatic adenocarcinoma

 -  Mesurable disease according to RECIST 1.1 criteria or non measurable disease

 -  Metastatic disease (synchronous or metachronous) or locally advanced / borderline
 deemed unresectable and / or patient inoperable due to his co-morbidities and / or
 local recurrence after surgery

 -  Thrombosis of the main portal vein and/or of one of its branches (endo-luminal defect
 on the injected CTscan) of cruoric or tumoral origin or circumferential stenosis of
 the portal vein trunk, the spleno-mesaraic confluence or one of its venous branches
 with or without signs of portal hypertension on CTscan and / or upper GIendoscopy

 Exclusion Criteria:

 -  - Post-surgical portal vein thrombosis and / or in patients considered in remission

 -  Non-adenocarcinomatous pancreatic tumor (endocrine, etc.)