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World Journal of Surgery

, Volume 34, Issue 11, pp 2648–2661 | Cite as

Vascular Reconstruction During Pancreatoduodenectomy for Ductal Adenocarcinoma of the Pancreas Improves Resectability but does not Achieve Cure

  • Mehdi Ouaissi
  • Catherine Hubert
  • Robert Verhelst
  • Parla Astarci
  • Christine Sempoux
  • Anne Jouret-Mourin
  • Anderson Loundou
  • Jean-François Gigot
  • The Multidisciplary HPB Group of Center of Cancer
Article

Abstract

Objective

Combined vascular and pancreatic resection improves long-term survival of patients suffering from ductal adenocarcinoma of the pancreatic head. This study was designed to compare the results of surgical resection in patients with pancreatic cancer with or without vascular resection. Late 10-year disease-free survival was considered as an indicator of patients’ disease cure.

Methods

A total of 149 consecutive patients have undergone pancreatoduodenectomy without vascular resection (group 1: 82 patients), with isolated venous resection (group B: 67 patients), or with arterial and/or venous resection (group C: 8 patients).

Results

The duration of surgery and blood losses were significantly more important in groups B and C compared with group A; however, postoperative morbidity and mortality rates were similar. R1 resection was significantly more frequent in groups B (42%) and C (50%) compared with group A (13%; p = 0.0002), but there were more advanced tumors in these groups, as demonstrated by a lower Karnowsky index, higher Ca 19-9 plasmatic level, greater tumor size, more advanced stage in the AJCC classification, and more tumor location in the uncinate process of the pancreas. Ten-year overall and disease-free survivals were significantly better in group A (19 and 20%) compared with group B (2.8 and 0%) and group C (0% and 0%). Multivariate analysis proved vascular resection and metastatic nodal status as being independent predictive factors of disease-free survival.

Conclusions

Vascular resection combined to pancreatoduodenectomy for pancreatic cancer increases local resectability without increasing mortality and morbidity rates but does not improve patients’ disease cure rate.

Keywords

Pancreatic Cancer Superior Mesenteric Artery Pancreatic Fistula Pancreatic Resection Superior Mesenteric Vein 
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.

Abbreviations

AJCC

American Joint Committee on Cancer

ASA

American Society of Anesthesiology

CT

Computed tomography

EUS

Endoscopic ultrasonography

FDG-Pet-CT

18-Fluorodeoxyglucose positron emission tomography

JPS

Japanese Pancreas Society

LN

Lymph nodes

MRI

Magnetic resonance imaging

PD

Pancreatoduodenectomy

POPF

Postoperative pancreatic fistula

PV

Portal vein

SMA

Superior mesenteric artery

SMV

Superior mesenteric vein

TP

Total pancreatectomy

US

Ultrasonography

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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Mehdi Ouaissi
    • 1
  • Catherine Hubert
    • 1
  • Robert Verhelst
    • 2
  • Parla Astarci
    • 2
  • Christine Sempoux
    • 3
  • Anne Jouret-Mourin
    • 3
  • Anderson Loundou
    • 4
  • Jean-François Gigot
    • 1
  • The Multidisciplary HPB Group of Center of Cancer
  1. 1.Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-LucUniversité Catholique de Louvain (UCL)BrusselsBelgium
  2. 2.Department of Cardiovascular Surgery, Cliniques Universitaires Saint-LucUniversité Catholique de Louvain (UCL)BrusselsBelgium
  3. 3.Department of Pathology, Cliniques Universitaires Saint-LucUniversité Catholique de Louvain (UCL)BrusselsBelgium
  4. 4.Faculty of MedicineUniversity Aix-Marseille IIMarseilleFrance

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