Vascular Reconstruction During Pancreatoduodenectomy for Ductal Adenocarcinoma of the Pancreas Improves Resectability but does not Achieve Cure
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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.
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).
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.
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.
KeywordsPancreatic Cancer Superior Mesenteric Artery Pancreatic Fistula Pancreatic Resection Superior Mesenteric Vein
American Joint Committee on Cancer
American Society of Anesthesiology
18-Fluorodeoxyglucose positron emission tomography
Japanese Pancreas Society
Magnetic resonance imaging
Postoperative pancreatic fistula
Superior mesenteric artery
Superior mesenteric vein
- 34.American Joint Commitee on Cancer, Greene FL PD, Fleming ID et al. (2002) AJCC cancer staging handbook, 6th ed. Springer-Verlag, New YorkGoogle Scholar
- 35.Society JP (2003) Classification of pancreatic carcinoma, 2nd edn. Kanehara and Co., Ltd., TokyoGoogle Scholar
- 56.Boggi U, Del Chiaro M, Croce C et al. (2009) Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 146:869–881Google Scholar
- 63.Turrini O, Viret F, Moureau-Zabotto L et al. (2009) Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinoma. Eur J Surg Oncol 35:1306–1311Google Scholar