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World Journal of Surgery

, Volume 30, Issue 8, pp 1526–1535 | Cite as

Pancreaticoduodenectomy with Mesentericoportal Vein Resection for Adenocarcinoma of the Pancreatic Head

  • Nicolas Carrère
  • Alain Sauvanet
  • Diane Goere
  • Reza Kianmanesh
  • Marie-Pierre Vullierme
  • Anne Couvelard
  • Philippe Ruszniewski
  • Jacques Belghiti
Article

Abstract

Background

The value of mesentericoportal vein resection (VR) associated with pancreaticoduodenectomy (PD) for pancreatic-head adenocarcinoma still remains controversial.

Methods

From 1989 to 2003, 45 consecutive patients with pancreatic-head adenocarcinoma underwent PD with mesentericoportal VR due to intraoperative macroscopic involvement of the superior mesenteric or portal vein (VR+ group). They were compared with 88 patients who underwent PD for adenocarcinoma without VR over the same time period (VR− group) and matched for age, American Society of Anesthesiologists (ASA) score, pathological diagnosis, and nodal involvement. Preoperative features, intraoperative parameters, postoperative course, and survival were compared between the VR+ group and VR− group. Factors that may influence survival were determined by univariate and multivariate analyses.

Results

Mortality, morbidity, and mean hospital stay did not differ between the two groups (VR+ 4.4%, 56%, and 22.6 days, respectively; VR− 5.7%, 64%, 24.6 days, respectively). In the group VR+, vein invasion was histologically proven in 29 (64%) patients. Three-year global survival and 3-year disease-free survival did not differ between the two groups: VR+ 22% and 14%, respectively; VR− 25% and 21%, respectively (log-rank: P = 0.69 and P = 0.39, respectively). Neither VR nor histologically proven vein involvement significantly impacted survival duration. On multivariate analysis, tumor-free margin was the most important prognostic factor.

Conclusions

Vein resection during PD can be performed safely. Patients with adenocarcinoma who require VR during PD have a survival not different from that of patients who undergo standard PD. Macroscopic isolated mesentericoportal vein involvement is not a contraindication for PD in patients with adenocarcinoma provided disease-free margins can be obtained.

Keywords

Pancreatic Fistula Mesenteric Root Retroperitoneal Margin Bile Duct Transection Bile Duct Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455–465PubMedCrossRefGoogle Scholar
  2. 2.
    Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–257PubMedCrossRefGoogle Scholar
  3. 3.
    Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–299PubMedGoogle Scholar
  4. 4.
    Neoptolemos JP, Russell RC, Bramhall S, et al. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg 1997;84:1370–1376PubMedCrossRefGoogle Scholar
  5. 5.
    Yeo CJ, Sohn TA, Cameron JL, et al. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 1998;227:821–831PubMedCrossRefGoogle Scholar
  6. 6.
    Bramhall SR, Allum WH, Jones AG, et al. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995;82:111–115PubMedGoogle Scholar
  7. 7.
    Sener SF, Fremgen A, Menck HR, et al. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 1999;189:1–7PubMedCrossRefGoogle Scholar
  8. 8.
    Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–347PubMedCrossRefGoogle Scholar
  9. 9.
    Fuhrman G, Leach S, Staley C, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 1996;223:154–162PubMedCrossRefGoogle Scholar
  10. 10.
    Leach S, Lee J, Charnsangavej C, et al. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg 1998;85:611–617PubMedCrossRefGoogle Scholar
  11. 11.
    Bachellier P, Nakano H, Oussoultzoglou P, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 2001;182:120–129PubMedCrossRefGoogle Scholar
  12. 12.
    Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–950PubMedCrossRefGoogle Scholar
  13. 13.
    Allema J, Reinders M, van Gulik T, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. Br J Surg 1994;81:1642–1646PubMedGoogle Scholar
  14. 14.
    Roder J, Stein H, Siewert J. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996;171:170–174PubMedCrossRefGoogle Scholar
  15. 15.
    Launois B, Stasik C, Bardaxoglou E, et al. Who benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J Surg 1999;23:926–929PubMedCrossRefGoogle Scholar
  16. 16.
    van Geenen RC, ten Kate FJ, de Wit LT, et al. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery 2001;129:158–163PubMedCrossRefGoogle Scholar
  17. 17.
    Capussotti L, Massucco P, Ribero D, et al. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 2003;138:1316–1322PubMedCrossRefGoogle Scholar
  18. 18.
    Miettinen OS. Individual matching with multiple controls in the case of all-or-none responses. Biometrics 1969;25:339–355PubMedCrossRefGoogle Scholar
  19. 19.
    Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: part 2: randomized controlled trial evaluating survival, morbidity and mortality. Ann Surg 2002;236:355–368PubMedCrossRefGoogle Scholar
  20. 20.
    Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998;228:508–517PubMedCrossRefGoogle Scholar
  21. 21.
    Varty PP, Yamamoto H, Farges O, et al. Early retropancreatic dissection during pancreaticoduodenectomy. Am J Surg 2005;189:488–491PubMedCrossRefGoogle Scholar
  22. 22.
    Munoz-Bongrand N, Sauvanet A, Denys A, et al. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 2004;199:198–203PubMedCrossRefGoogle Scholar
  23. 23.
    Hamilton SR, Aaltonen LA. Pathology and genetics of tumours of the digestive system. Washington, DC, IARC Press, 2000Google Scholar
  24. 24.
    (UICC) IUAC. TNM: classification of malignant tumours. 6th ed. Ed. New York, NY, Wiley, 2002Google Scholar
  25. 25.
    Poon R, Fan S, Lo C, et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 2004;28:602–608PubMedCrossRefGoogle Scholar
  26. 26.
    Andersen HB, Baden H, Brahe NE, Burcharth F. Pancreaticoduodenectomy for periampullary adenocarcinoma. J Am Coll Surg 1994;179:545–552PubMedGoogle Scholar
  27. 27.
    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. Ann Surg 1999;230:776–782PubMedCrossRefGoogle Scholar
  28. 28.
    Neoptolemos JP, Dunn JA, Stocken DD, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 2001;358:1576–1585PubMedCrossRefGoogle Scholar
  29. 29.
    Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210PubMedCrossRefGoogle Scholar
  30. 30.
    Stojadinovic A, Brooks A, Hoos A, et al. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 2003;196:954–964PubMedCrossRefGoogle Scholar
  31. 31.
    Koniaris LG, Schoeniger LO, Kovach S, et al. The quick, no-twist, no-kink portal confluence reconstruction. J Am Coll Surg 2003;196:490–494PubMedCrossRefGoogle Scholar
  32. 32.
    Clavien P, Rudiger H. A simple technique of portal vein resection and reconstruction during pancreaticoduodenectomy. J Am Coll Surg 1999;189:629–634PubMedCrossRefGoogle Scholar
  33. 33.
    Howard TJ, Villanustre N, Moore SA, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 2003;7:1089–1095PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Nicolas Carrère
    • 1
  • Alain Sauvanet
    • 1
  • Diane Goere
    • 1
  • Reza Kianmanesh
    • 1
  • Marie-Pierre Vullierme
    • 1
  • Anne Couvelard
    • 1
  • Philippe Ruszniewski
    • 1
  • Jacques Belghiti
    • 1
  1. 1.Departments of Digestive Surgery (NC, AS, DG, RK, JB), Radiology (MPV), Pathology (AC), and Gastroenterology (PR), AP-HPHôpital Beaujon, University Paris VIIClichy CedexFrance

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