Surgical, survival, and oncological outcomes after vascular resection in robotic and open pancreaticoduodenectomy

  • Bor-Uei Shyr
  • Shih-Chin Chen
  • Yi-Ming Shyr
  • Shin-E WangEmail author



To evaluate the surgical, oncological, and survival outcomes after pancreaticoduodenectomy (PD) with superior mesenteric vein (SMV)/portal vein (PV) resection by either robotic PD (RPD) or open PD (OPD).


Data of patients with periampullary lesions undergoing PD were retrieved from a prospectively collected computer database. Surgical risks as well as oncological and survival outcomes were compared between patients with (vein resection group) and without SMV/PV resection (without vein resection group).


A total of 391 patients undergoing pancreaticoduodenectomy were enrolled, including 43 (11.0%) and 384 (89.0%) patients with and without vein resection, respectively. Eleven (25.6%) of PDs with vein resection were performed using the robotic approach. Operation time in the vein resection group was significantly longer (median of 8 vs. 7 h). Blood loss, curative resection (R0) rate, and harvested lymph node number were similar between these two groups. Surgical outcomes including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), chyle leakage, wound infection, and hospital stay were not significantly different between the two groups. There was no survival difference between these groups, with 1- and 3-year survival rates of 92.6% and 26.5%, respectively, for vein resection group, vs. 70.3% and 37.2%, respectively, for the without vein resection group.


PD with vein resection is technically feasible by OPD and RPD in selected patients. Additional SMV/PV would not increase the surgical risks of PD and could achieve similar survival outcomes for pancreatic head adenocarcinoma when compared to PD without vein resection.


Pancreaticoduodenectomy Robotic Vein resection 



This work was financially supported by grants from the Taipei Veterans General Hospital (V106C-028, VTA106-V1-1-1), the Ministry of Science and Technology (MOST 106-2314-B-075-048-MY2), and the Ministry of Health and Welfare (MOHW107-TDU-B-212-114026A).


Bor-Uei Shyr, Shih-Chin Chen, Yi-Ming Shyr, and Shin-E Wang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102(4):763–779CrossRefGoogle Scholar
  2. 2.
    Snyder RA, Prakash LR, Nogueras-Gonzalez GM, Kim MP, Aloia TA, Vauthey JN, Lee JE, Fleming JB, Katz MHG, Tzeng CD (2018) Vein resection during pancreaticoduodenectomy for pancreatic adenocarcinoma: patency rates and outcomes associated with thrombosis. J Surg Oncol 117(8):1648–1654CrossRefGoogle Scholar
  3. 3.
    Cullen JJ, Sarr MG, Ilstrup DM (1994) Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg 168(4):295–298CrossRefGoogle Scholar
  4. 4.
    Wang KC, Shyr YM, Wang SE, Su CH, Chen TH, Wu CW (2012) Reappraisal of pancreatic adenocarcinoma undergoing pancreaticoduodenectomy. Hepatogastroenterology 59(118):1976–1980Google Scholar
  5. 5.
    Shyr YM, Chen TH, Su CH, Wu CW, Lui WY (2005) Non-stented pancreaticogastrostomy for 111 patients undergoing pylorus-preserving pancreaticoduodenectomy. Hepatogastroenterology 52(61):253–257Google Scholar
  6. 6.
    Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–257 (discussion 57-60)Google Scholar
  7. 7.
    Kleespies A, Rentsch M, Seeliger H, Albertsmeier M, Jauch KW, Bruns CJ (2009) Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg 96(7):741–750CrossRefGoogle Scholar
  8. 8.
    Kleespies A, Albertsmeier M, Obeidat F, Seeliger H, Jauch KW, Bruns CJ (2008) The challenge of pancreatic anastomosis. Langenbecks Arch Surg 393(4):459–471CrossRefGoogle Scholar
  9. 9.
    Mishra PK, Saluja SS, Gupta M, Rajalingam R, Pattnaik P (2001) Blumgart’s technique of pancreaticojejunostomy: an appraisal. Dig Surg 28(4):281–287CrossRefGoogle Scholar
  10. 10.
    Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, Hattori M, Inokawa Y, Nomoto S, Fujiwara M, Kodera Y (2014) Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg 18(6):1108–1115CrossRefGoogle Scholar
  11. 11.
    Moore GE, Sako Y, Thomas LB (1951) Radical pancreatoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery 30(3):550–553Google Scholar
  12. 12.
    Landi F, Dopazo C, Sapisochin G, Beisani M, Blanco L, Caralt M, Balsells J, Charco R (2015) Long-term results of pancreaticoduodenectomy with superior mesenteric and portal vein resection for ductal adenocarcinoma in the head of the pancreas. Cir Esp 93(8):522–529CrossRefGoogle Scholar
  13. 13.
    Kulemann B, Hoeppner J, Wittel U, Glatz T, Keck T, Wellner UF, Bronsert P, Sick O, Hopt UT, Makowiec F, Riediger H (2015) Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer. J Gastrointest Surg 19(3):438–444CrossRefGoogle Scholar
  14. 14.
    Ravikumar R, Sabin C, Abu Hilal M, Bramhall S, White S, Wigmore S, Imber CJ, Fusai G; UK Vascular Resection in Pancreatic Cancer Study Group (2014) Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg 218(3):401–411CrossRefGoogle Scholar
  15. 15.
    Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M (2003) Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 138(12):1316–1322CrossRefGoogle Scholar
  16. 16.
    Cloyd JM, Katz MH, Prakash L, Varadhachary GR, Wolff RA, Shroff RT, Javle M, Fogelman D, Overman M, Crane CH, Koay EJ, Das P, Krishnan S, Minsky BD, Lee JH, Bhutani MS, Weston B, Ross W, Bhosale P, Tamm EP, Wang H, Maitra A, Kim MP, Aloia TA, Vauthey JN, Fleming JB, Abbruzzese JL, Pisters PW, Evans DB, Lee JE (2017) Preoperative therapy and pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a 25-year single-institution experience. J Gastrointest Surg 21(1):164–174CrossRefGoogle Scholar
  17. 17.
    Cheung TT, Poon RT, Chok KS, Chan AC, Tsang SH, Dai WC, Chan SC, Fan ST, Lo CM (2014) Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability. World J Gastroenterol 20(46):17448–17455CrossRefGoogle Scholar
  18. 18.
    Menon VGPV, Annamalai AA, Tuli R, Nissen NN (2013) Outcomes of vascular resection in pancreaticoduodenectomy single-surgeon experience. Am Surg 79(10):1064–1067Google Scholar
  19. 19.
    Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14(9):1442–1452CrossRefGoogle Scholar
  20. 20.
    Liles JS, Katz MH (2014) Pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma. Expert Rev Anticancer Ther 14(8):919–929CrossRefGoogle Scholar
  21. 21.
    Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S (2003) Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 186(2):149–153CrossRefGoogle Scholar
  22. 22.
    Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, Uzuki M, Sawai T, Yamazaki T (2001) Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg 25(8):1002–1005CrossRefGoogle Scholar
  23. 23.
    Castleberry AW, White RR, De La Fuente SG, Clary BM, Blazer DG 3rd, McCann RL, Pappas TN, Tyler DS, Scarborough JE (2012) The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Ann Surg Oncol 19(13):4068–4077CrossRefGoogle Scholar
  24. 24.
    Kantor O, Talamonti MS, Wang CH, Roggin KK, Bentrem DJ, Winchester DJ, Prinz RA, Baker MS (2018) The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy. HPB (Oxford) 20(2):140–146CrossRefGoogle Scholar
  25. 25.
    Muller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, Schmied BM, Büchler MW (2009) Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 13(4):784–792CrossRefGoogle Scholar
  26. 26.
    Wang SE, Chen SC, Shyr BU, Shyr YM (2016) Comparison of Modified Blumgart pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. HPB (Oxford) 18(3):229–235CrossRefGoogle Scholar
  27. 27.
    Wang SE, Shyr BU, Chen SC, Shyr YM (2018) Comparison between robotic and open pancreaticoduodenectomy with modified Blumgart pancreaticojejunostomy: a propensity score-matched study. Surgery. Google Scholar
  28. 28.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRefGoogle Scholar
  29. 29.
    Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25CrossRefGoogle Scholar
  30. 30.
    Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768CrossRefGoogle Scholar
  31. 31.
    Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Büchler MW, Busch OR, Charnley RM, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ; International Study Group on Pancreatic Surgery (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161(2):365–372CrossRefGoogle Scholar
  32. 32.
    Wittekind C, Compton CC, Greene FL, Sobin LH (2001) TNM residual tumor classification revisited. Cancer 94(9):2511–2516CrossRefGoogle Scholar
  33. 33.
    Christians K, Evans DB (2009) Pancreaticoduodenectomy and vascular resection: persistent controversy and current recommendations. Ann Surg Oncol 16(4):789–791CrossRefGoogle Scholar
  34. 34.
    Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB 3rd, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O’Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S (2007) Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 15(8):1028–1061Google Scholar
  35. 35.
    Porembka MR, Hawkins WG, Linehan DC, Gao F, Ma C, Brunt EM, Strasberg SM (2011) Radiologic and intraoperative detection of need for mesenteric vein resection in patients with adenocarcinoma of the head of the pancreas. HPB (Oxford) 13(9):633–642CrossRefGoogle Scholar
  36. 36.
    Worni M, Castleberry AW, Clary BM, Gloor B, Carvalho E, Jacobs DO, Pietrobon R, Scarborough JE, White RR (2013) Concomitant vascular reconstruction during pancreatectomy for malignant disease: a propensity score-adjusted, population-based trend analysis involving 10,206 patients. JAMA Surg 148(4):331–338CrossRefGoogle Scholar
  37. 37.
    Kantor O, Talamonti MS, Stocker SJ, Wang CH, Winchester DJ, Bentrem DJ, Prinz RA, Baker MS (2016) A graded evaluation of outcomes following pancreaticoduodenectomy with major vascular resection in pancreatic cancer. J Gastrointest Surg 20(2):284–292CrossRefGoogle Scholar
  38. 38.
    Cherukuru R, Govil S, Vij M, Rela M (2018) Vein resection in patients with adenocarcinoma of the head of pancreas adherent to the portomesenteric venous axis is beneficial despite a high rate of R1 resection. Ann Hepatobiliary Pancreat Surg 22(3):261–268CrossRefGoogle Scholar
  39. 39.
    Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Gomez HF, Sun CC, Crane CH, Wolff RA, Evans DB (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8(8):935–949 (discussion 49–50)Google Scholar
  40. 40.
    Allan BJ, Novak SM, Hogg ME, Zeh HJ (2018) Robotic vascular resections during Whipple procedure. J Vis Surg 4:13CrossRefGoogle Scholar
  41. 41.
    Kauffmann EF, Napoli N, Menonna F, Vistoli F, Amorese G, Campani D, Pollina LE, Funel N, Cappelli C, Caramella D, Boggi U (2016) Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 401(8):1111–1122CrossRefGoogle Scholar
  42. 42.
    Podda M, Thompson J, Kulli CTG, Tait IS (2017) Vascular resection in pancreaticoduodenectomy for periampullary cancers. A 10 year retrospective cohort study. Int J Surg 39:37–44CrossRefGoogle Scholar
  43. 43.
    Chen S, Chen JZ, Zhan Q, Deng XX, Shen BY, Peng CH, Li HW (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Sur Endosc 29(12):3698–3711CrossRefGoogle Scholar
  44. 44.
    Campbell F, Smith RA, Whelan P, Sutton R, Raraty M, Neoptolemos JP, Ghaneh P (2009) Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology 55(3):277–283CrossRefGoogle Scholar
  45. 45.
    Verbeke CS, Menon KV (2009) Redefining resection margin status in pancreatic cancer. HPB (Oxford) 11(4):282–289CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Bor-Uei Shyr
    • 1
  • Shih-Chin Chen
    • 1
  • Yi-Ming Shyr
    • 1
  • Shin-E Wang
    • 1
    • 2
    Email author
  1. 1.Departments of Surgery, Taipei Veterans General HospitalNational Yang Ming UniversityTaipeiTaiwan
  2. 2.Division of General Surgery, Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan

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