Extended Pancreaticoduodenectomy with Vascular Resection for Pancreatic Cancer: A Systematic Review
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This systematic review objectively evaluates the safety and outcomes of extended pancreaticoduodenectomy with vascular resection for pancreatic cancer involving critical adjacent vessels namely the superior mesenteric-portal veins, hepatic artery, superior mesenteric artery, and celiac axis.
Electronic searches were performed on two databases from January 1995 to August 2009. The end points were: firstly, to evaluate the safety through reporting the mortality rate and associated complications and, secondly, the outcome by reporting the survival after surgery. This was synthesized through a narrative review with full tabulation of results of all included studies.
Twenty-eight retrospective studies comprising of 1,458 patients were reviewed. Vein thrombosis and arterial involvement were reported as contraindications to surgery in 62% and 71% of studies, respectively. The median mortality rate was 4% (range, 0% to 17%). The median R0 and R1 rates were 75% (range, 14% to 100%) and 25% (range, 0% to 86%), respectively. In high volume centers, the median survival was 15 months (range, 9 to 23 months). Nine of 10 (90%) studies comparing the survival after extended pancreaticoduodenectomy with vascular resection versus standard pancreaticoduodenectomy reported statistically similar (p > 0.05) survival outcomes. Undertaking vascular resection was not associated with a poorer survival.
The morbidity, mortality, and survival outcome after undertaking extended pancreaticoduodenectomy with vascular resection for pancreatic cancer with venous involvement and/or limited arterial involvement is acceptable in the setting of an expert referral center and should not be a contraindication to a curative surgery.
- Oettle, H, Post, S, Neuhaus, P (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297: pp. 267-277 CrossRef
- Ueno, H, Kosuge, T, Matsuyama, Y (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101: pp. 908-915 CrossRef
- Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group.[see comment]. Ann Surg 1999;230:776–782; discussion 782–774.
- Louvet, C, Labianca, R, Hammel, P (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23: pp. 3509-3516 CrossRef
- Chauffert, B, Mornex, F, Bonnetain, F (2008) Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 19: pp. 1592-1599 CrossRef
- Fortner, JG (1973) Regional resection of cancer of the pancreas: a new surgical approach.. Surgery 73: pp. 307-320
- Michalski, CW, Kleeff, J, Wente, MN (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94: pp. 265-273 CrossRef
- Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005;138:618–628; discussion 628–630.
- House, MG, Gonen, M, Jarnagin, WR (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. Journal of Gastrointestinal Surgery 11: pp. 1549-1555 CrossRef
- Merchant NB, Rymer J, Koehler EAS, et al. Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits? J Am Coll Surg 2009;208:829–838; discussion 838–841.
- Siriwardana, HPP, Siriwardena, AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer.[see comment]. Br J Surg 93: pp. 662-673 CrossRef
- Ramacciato G, Mercantini P, Petrucciani N, Giaccaglia V, Nigri G, Ravaioli M, Cescon M, Cucchetti A, Del Gaudio M. Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 2009;16(4):817–825
- Al-Haddad, M, Martin, JK, Nguyen, J (2007) Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. Journal of Gastrointestinal Surgery 11: pp. 1168-1174 CrossRef
- Bachellier, P, Nakano, H, Oussoultzoglou, PD (2001) Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile?. Am J Surg 182: pp. 120-129 CrossRef
- Capussotti, L, Massucco, P, Ribero, D (2003) Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 138: pp. 1316-1322 CrossRef
- Carrere, N, Sauvanet, A, Goere, D (2006) Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg 30: pp. 1526-1535 CrossRef
- Howard, TJ, Villanustre, N, Moore, SA (2003) Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. Journal of Gastrointestinal Surgery 7: pp. 1089-1095 CrossRef
- Illuminati, G, Carboni, F, Lorusso, R (2008) Results of a pancreatectomy with a limited venous resection for pancreatic cancer. Surg Today 38: pp. 517-523 CrossRef
- Kaneoka, Y, Yamaguchi, A, Isogai, M (2009) Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery 145: pp. 417-425 CrossRef
- Koniaris, LG, Staveley-O’Carroll, KF, Zeh, HJ (2005) Pancreaticoduodenectomy in the presence of superior mesenteric venous obstruction. Journal of Gastrointestinal Surgery 9: pp. 915-921 CrossRef
- Li, B, Chen, FZ, Ge, XH (2004) Pancreatoduodenectomy with vascular reconstruction in treating carcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int 3: pp. 612-615
- Martin, RCG, Scoggins, CR, Egnatashvili, V (2009) Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg 144: pp. 154-159 CrossRef
- Muller, SA, Hartel, M, Mehrabi, A (2009) Vascular resection in pancreatic cancer surgery: survival determinants. Journal of Gastrointestinal Surgery 13: pp. 784-792 CrossRef
- Poon, RT, Fan, ST, Lo, CM (2004) Pancreaticoduodenectomy with En Bloc Portal Vein Resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 28: pp. 602-608 CrossRef
- Riediger, H, Makowiec, F, Fischer, E (2006) Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. Journal of Gastrointestinal Surgery 10: pp. 1106-1115 CrossRef
- Shibata, C, Kobari, M, Tsuchiya, T (2001) Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg 25: pp. 1002-1005 CrossRef
- Shimada, K, Sano, T, Sakamoto, Y, Kosuge, T (2006) Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol 13: pp. 1569-1578 CrossRef
- Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–949; discussion 949–950.
- Geenen, RC, Kate, FJ, Wit, LT (2001) Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery 129: pp. 158-163 CrossRef
- Wang, C, Wu, H, Xiong, J (2008) Pancreaticoduodenectomy with vascular resection for local advanced pancreatic head cancer: a single center retrospective study. Journal of Gastrointestinal Surgery 12: pp. 2183-2190 CrossRef
- Yekebas, EF, Bogoevski, D, Cataldegirmen, G (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 247: pp. 300-309 CrossRef
- Zhou, GW, Wu, WD, Xiao, WD (2005) Pancreatectomy combined with superior mesenteric-portal vein resection: report of 32 cases. Hepatobiliary Pancreat Dis Int 4: pp. 130-134
- Jain, S, Sacchi, M, Vrachnos, P, Lygidakis, NJ (2005) Carcinoma of the pancreas with portal vein involvement - our experience with a modified technique of resection. Hepatogastroenterology 52: pp. 1596-1600
- Kawada, M, Kondo, S, Okushiba, S (2002) Reevaluation of the indications for radical pancreatectomy to treat pancreatic carcinoma: is portal vein infiltration a contraindication?. Surg Today 32: pp. 598-601 CrossRef
- Nakao A, Takeda S, Inoue S, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30:976–982; discussion 983–974.
- Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996;171:170–174; discussion 174–175.
- Stitzenberg, KB, Watson, JC, Roberts, A (2008) Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 15: pp. 1399-1406 CrossRef
- Launois, B, Stasik, C, Bardaxoglou, E (1999) Who Benefits from Portal Vein Resection during Pancreaticoduodenectomy for Pancreatic Cancer?. World J Surg 23: pp. 926-929 CrossRef
- Nakagohri, T, Kinoshita, T, Konishi, M (2003) Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 186: pp. 149-153 CrossRef
- Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–347; discussion 347–349.
- Cameron, JL, Riall, TS, Coleman, J, Belcher, KA (2006) One Thousand Consecutive Pancreaticoduodenectomies. Ann Surg 244: pp. 10-15 CrossRef
- Wilentz, RE, Hruban, RH (1998) Pathology of cancer of the pancreas. Surg Oncol Clin N Am 7: pp. 43-65
- Extended Pancreaticoduodenectomy with Vascular Resection for Pancreatic Cancer: A Systematic Review
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