Pancreaticoduodenectomy and Vascular Resection: Persistent Controversy and Current Recommendations
In this issue of the Journal, Giovanni and colleagues analyze 12 recent manuscripts which reported the outcome of patients with pancreatic cancer who required portal vein (PV) or superior mesenteric vein (SMV) resection at the time of pancreaticoduodenectomy (PD).1 They conclude that venous resection can be safely performed and should be considered in appropriately selected patients. Fortner first popularized vascular resection at the time of PD in 1973 when he proposed the use of “regional pancreatectomy.”2 However, this concept has remained controversial for the following reasons:
Most physicians do not understand the difference between the historical experience with regional pancreatectomy and isolated tumor resection of the SMV, PV or superior mesenteric–portal vein (SMPV) confluence performed as part of a gross complete resection of the primary tumor. Vascular resection at the time of PD was initially performed in an attempt to improve survival duration by performing an en bloc r ...
- Giovanni R, Paolo M, Niccolo P, et al. Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol. 2009. DOI:10.1245/s10434-008-0281-8.
- Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973;73:307–20.
- Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—part 3: update on 5-year survival. J Gastrointest Surg. 2005;9:1191–204; discussion 204–6. CrossRef
- Pawlik TM, Abdalla EK, Barnett CC,, Ahmad SA, Cleary KR, Vauthey JN, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005;140:584–9; discussion 9–91. CrossRef
- Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60. CrossRef
- Allard WJ, Matera J, Miller MC, Repollet M, Connelly MC, Rao C, et al. Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases. Clin Cancer Res. 2004;10:6897–6904. CrossRef
- Husemann Y, Geigl JB, Schubert F, Musiani P, Meyer M, Burghart E, et al. Systemic spread is an early step in breast cancer. Cancer Cell. 2008;13:58–68. CrossRef
- Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49. CrossRef
- Katz MHG, Fleming JB, Pisters PWT, Lee JE, Evans DB. Anatomy of the superior mesenteric vein with special reference to the surgical management of first-order branch involvement at pancreaticoduodenectomy. Ann Surg. 2008;248(6):1098–102. CrossRef
- Exocrine pancreas. In: Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al., editors. AJCC cancer staging manual. New York: Springer; 2002. p. 157–64.
- Pancreaticoduodenectomy and Vascular Resection: Persistent Controversy and Current Recommendations
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Annals of Surgical Oncology
Volume 16, Issue 4 , pp 789-791
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