Surgery Today

, 38:517 | Cite as

Results of a pancreatectomy with a limited venous resection for pancreatic cancer

  • Giulio Illuminati
  • Fabio Carboni
  • Riccardo Lorusso
  • Antonio D’Urso
  • Gianluca Ceccanei
  • Vassilios Papaspyropoulos
  • Maria Antonietta Pacile
  • Eugenio Santoro
Original Article

Abstract

Purpose

The indications for a pancreatectomy with a partial resection of the portal or superior mesenteric vein for pancreatic cancer, when the vein is involved by the tumor, remain controversial. It can be assumed that when such involvement is not extensive, resection of the tumor and the involved venous segment, followed by venous reconstruction will extend the potential benefits of this resection to a larger number of patients. The further hypothesis of this study is that whenever involvement of the vein by the tumor does not exceed 2 cm in length, this involvement is more likely due to the location of the tumor being close to the vein rather than because of its aggressive biological behavior. Consequently, in these instances a pancreatectomy with a resection of the involved segment of portal or superior mesenteric vein for pancreatic cancer is indicated, as it will yield results that are superposable to those of a pancreatectomy for cancer without vascular involvement.

Methods

Twenty-nine patients with carcinoma of the pancreas involving the portal or superior mesenteric vein over a length of 2 cm or less underwent a macroscopically curative resection of the pancreas en bloc with the involved segment of the vein. The venous reconstruction procedures included a tangential resection/lateral suture in 15 cases, a resection/end-to-end anastomosis in 11, and a resection/patch closure in 3.

Results

Postoperative mortality was 3.4%; morbidity was 21%. Local recurrence was 14%. Cumulative (standard error) survival rate was 17% (9%) at 3 years.

Conclusion

A pancreatectomy combined with a resection of the portal or superior mesenteric vein for cancer with venous involvement not exceeding 2 cm is indicated in order to extend the potential benefits of a curative resection.

Key words

Pancreatic cancer Vascular resection Portal vein Superior mesenteric vein 

References

  1. 1.
    Howard TF, Villamustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 2003;7:1089–1095.PubMedCrossRefGoogle Scholar
  2. 2.
    Klempnauer J, Ridder GJ, Bektas H, Pichlmayr R. Surgery for exocrine pancreatic cancer — who are the 5 and 10-year survivors? Oncology 1995;52:353–359.PubMedCrossRefGoogle Scholar
  3. 3.
    Schafer M, Mullhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg 2002;236:137–148.PubMedCrossRefGoogle Scholar
  4. 4.
    Armaki M, Matsumoto T, Etoh T, Ishio T, Himeno Y, Sasaki A, et al. Clinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma. Hepatogastroenterology 2003;50:263–266.Google Scholar
  5. 5.
    Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery 1973;73:307–320.PubMedGoogle Scholar
  6. 6.
    Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 1989;124:127–122.PubMedGoogle Scholar
  7. 7.
    Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg 1996;223:718–725.PubMedCrossRefGoogle Scholar
  8. 8.
    Cameron JL, Crist DW, Sitzmann JV, Hruban RH, Boitnott JK, Seidler AJ, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 1991;161:120–125.PubMedCrossRefGoogle Scholar
  9. 9.
    Trede M, Schwall G, Saeger HD. Survival after pancreaticoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg 1990;211:447–458.PubMedCrossRefGoogle Scholar
  10. 10.
    Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 2004;28:602–608.PubMedCrossRefGoogle Scholar
  11. 11.
    Kawada M, Kondo S, Okushiba S, Morikawa T, Kato H. Reevaluation of the indications for radical pancreatectomy to treat pancreatic carcinoma: is portal vein infiltration a contraindication? Surg Today 2002;32:598–601.PubMedCrossRefGoogle Scholar
  12. 12.
    Fuhrman GM, Leach SD, Staley CA, Cusak JC, Charnsangavei C, Cleary KR, 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;223:154–162.PubMedCrossRefGoogle Scholar
  13. 13.
    Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowry AM, Fenoglio CJ, et al. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal confluence for adenocarcinoma of the pancreatic head. Br J Surg 1998;85:611–617.PubMedCrossRefGoogle Scholar
  14. 14.
    Allema JH, Reinders ME, Van Gulik TM, Van Leeuwen DJ, De Wit LT, Verbeek PC, et al. Portal vein resection in patients undergoing pancreaticoduodenectomy for carcinoma of the pancreatic head. Br J Surg 1994;81:1642–1646.PubMedCrossRefGoogle Scholar
  15. 15.
    Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996;171:170–175.PubMedCrossRefGoogle Scholar
  16. 16.
    Kremer B, Vogel I, Luttges J, Kloppel G, Henne-Bruns D. Surgical possibilities for pancreatic cancer: extended resection. Ann Oncol 1999;10(s):252–256.PubMedCrossRefGoogle Scholar
  17. 17.
    Launois B, Stasik C, Bardaxoglou E, Meunier B, Campion JP, Greco L, et al. Who benefits from portal vein resection during pancreatoduodenectomy for pancreatic cancer. World J Surg 1999;23:926–929.PubMedCrossRefGoogle Scholar
  18. 18.
    Van Geenen RC, Ten Kate FJ, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery 2001;129:158–163.PubMedCrossRefGoogle Scholar
  19. 19.
    Capussotti L, Massucco P, Ribero D, Vigano’ L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer. Arch Surg 2003;138:1316–1322.PubMedCrossRefGoogle Scholar
  20. 20.
    International Union Against Cancer (UICC). TNM: classification of malignant tumour. 6th ed. New York: Wiley-Liss; 2002.Google Scholar
  21. 21.
    Bold RJ, Charnsangavej C, Cleary KR, Jennings M, Madray A, Leach SD, et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative and pathologic analysis. J Gastrointest Surg 1999;3:233–243.PubMedCrossRefGoogle Scholar
  22. 22.
    Staley CA, Cleary KR, Abbruzzese JL, Lee JE, Ames FC, Fenoglio CJ, et al. The need for standardized pathologic staging of pancreaticoduodenectomy specimens. Pancreas 1996;12:373–380.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaplan ER, Meier P. Nonparametric estimations for incomplete observations. J Am Stat Assoc 1958;53:457–481.CrossRefGoogle Scholar
  24. 24.
    Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 1995;221:721–733.PubMedCrossRefGoogle Scholar
  25. 25.
    Neoptolemos JP, Russell RC, Bramhall S, Theis B. 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;84:1370–1376.PubMedCrossRefGoogle Scholar
  26. 26.
    Onoue S, Katoh T, Chigira H, Shibata Y, Matsuo K, Suzuki M. Carcinoma of the head of the pancreas. Hepatogastroenterology 2002;49:549–552.PubMedGoogle Scholar
  27. 27.
    Nakao A, Takeda S, Sakai M, Kaneko T, Inoue S, Sugimoto H, et al. Extended radical resection versus standard resection for pancreatic cancer. Pancreas 2004;28:289–292.PubMedCrossRefGoogle Scholar
  28. 28.
    Kayahara M, Nagakawa T, Konishi I, Ueno K, Ohta T, Miyazaki I. Clinicopathological study of pancreatic carcinoma with particular reference to the invasion of the extrapancreatic neural plexus. Int J Pancreatol 1991;10:105–111.PubMedCrossRefGoogle Scholar
  29. 29.
    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;8:935–950.PubMedCrossRefGoogle Scholar
  30. 30.
    Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30:976–982.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • Giulio Illuminati
    • 1
  • Fabio Carboni
    • 2
  • Riccardo Lorusso
    • 2
  • Antonio D’Urso
    • 1
  • Gianluca Ceccanei
    • 1
  • Vassilios Papaspyropoulos
    • 1
  • Maria Antonietta Pacile
    • 1
  • Eugenio Santoro
    • 2
  1. 1.Francesco Durante Department of SurgeryUniversity of Rome La SapienzaRomeItaly
  2. 2.Department of Digestive Surgery and Liver TransplantationRegina Elena Cancer InstituteRomeItaly

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