Journal of Gastrointestinal Surgery

, Volume 12, Issue 5, pp 907–918

Portal Vein Resection in Surgery for Cancer of Biliary Tract and Pancreas: Special Reference to the Relationship Between the Surgical Outcome and Site of Primary Tumor

  • Isao Kurosaki
  • Katsuyoshi Hatakeyama
  • Masahiro Minagawa
  • Daisuke Sato
original article



Early and late outcomes after superior mesenteric-portal vein resection (VR) combined with pancreaticoduodenectomy, major hepatectomy, or both for pancreaticobiliary carcinoma were retrospectively evaluated. VR is the most frequently used vascular procedure in this field, but an exact role of VR has not been compared according to the primary site of tumor.

Materials and Methods

Postoperative outcomes were compared between surgery with and without VR in each of the three disease-based groups: hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma with hilar extension (HIC, 56), middle and distal cholangiocarcinoma and gallbladder carcinoma (DGC, 118), and pancreatic head adenocarcinoma (PHC, 77).


VR was performed in 19.6% of HIC, 8.5% of DGC, and 45.5% of PHC. In-hospital death was 7.1% (4 of 56) patients with VR (3 of DGC and 1 of PHC). Operations with VR in DGC showed a larger amount of blood loss and more increased ratio of R1operation than those with no VR. In HIC, DGC, and PHC, median survival time of patients with VR was 37, 6.8, and 20 months and that of patients without VR was 42.9, 28.6, and 20.3 months, respectively. VR did not affect survival either in HIC or in PHC; however, in DGC, VR was accompanied with dismal outcome compared with no VR (p = 0.001).


Aggressive surgery with VR can be justified both in HIC and in PHC but should not be recommended for DGC. Surgical outcomes of VR differed considerably, depending on the sites of the primary tumor.


Portal vein resection Morbidity Mortality Biliary tract cancer Pancreatic cancer 


  1. 1.
    Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg. 1991;78:727–731.PubMedCrossRefGoogle Scholar
  2. 2.
    Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–727.PubMedCrossRefGoogle Scholar
  3. 3.
    Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–818.PubMedCrossRefGoogle Scholar
  4. 4.
    Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C, Lopez-Hänninen E, Hintze RE. Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg. 2003;388:194–200.PubMedCrossRefGoogle Scholar
  5. 5.
    Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Katoh H. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240:95–101.PubMedCrossRefGoogle Scholar
  6. 6.
    Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241:693–699.PubMedCrossRefGoogle Scholar
  7. 7.
    Tashiro S, Uchino R, Hiraoka T, Tsuji T, Kawamoto S, Saitoh N, Yamasaki K, Miyauchi Y. Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Surgery. 1991;109:481–487.PubMedGoogle Scholar
  8. 8.
    Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, Misuta K, Sekido H, Togo S. Hepatic resection combined with portal vein or hepatic artery reconstruction for advanced carcinoma of the hilar bile duct and gallbladder. World J Surg. 2003;27:1137–1142.PubMedCrossRefGoogle Scholar
  9. 9.
    Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K, Yuasa N, Sano T, Hayakawa N. Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma. World J Surg. 2003;27:272–277.PubMedCrossRefGoogle Scholar
  10. 10.
    Fortner JG, Kim DK, Cubilla A, Turnbull A, Pahnke LD, Shils ME. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg. 1977;186:42–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Ishikawa O, Ohigashi H, Imaoka S, Furukawa H, Sasaki Y, Fujita M, Kuroda C, Iwanaga T. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg. 1992;215:231–236.PubMedCrossRefGoogle Scholar
  12. 12.
    Nakao A, Harada A, Nonami T, Kaneko T, Inoue S, Takagi H. Clinical significance of portal invasion by pancreatic head carcinoma. Surgery. 1995;117:50–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, El-Naggar AK, Fenoglio CJ, Lee JE, Evans DB. 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
  14. 14.
    Carrere N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, Ruszniewski P, Belghiti J. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–1535.PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    Hartel M, Niedergethmann M, Farag-Soliman M, Sturm JW, Richter A, Trede M, Post S. Benefit of venous resection for ductal adenocarcinoma of the pancreatic head. Eur J Surg. 2002;168:707–712.PubMedCrossRefGoogle Scholar
  17. 17.
    Henne-Bruns D, Vogel I, Luttges J, Kloppel G, Kremer B. Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications, and survival after regional versus extended lymphadenectomy. World J Surg. 2000;24:595–601.PubMedCrossRefGoogle Scholar
  18. 18.
    Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Gomez HF, Sun CC, Crane CH, Wolff RA, Evans DB. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–949.PubMedCrossRefGoogle Scholar
  19. 19.
    Capussotti L, Massucco P, Ribero D, Viganò L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–1322.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg. 2003;186:149–153.PubMedCrossRefGoogle Scholar
  21. 21.
    Sasson AR, Hoffman JP, Ross EA, Kagan SA, Pingpank JF, Eisenberg BL. En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg. 2002;6:147–157.PubMedCrossRefGoogle Scholar
  22. 22.
    Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, Jaeck D. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001;182:120–129.PubMedCrossRefGoogle Scholar
  23. 23.
    Shibata K, Matsumoto T, Yada K, Sasaki A, Ohta M, Kitano S. Factors predicting recurrence after resection of pancreatic ductal carcinoma. Pancreas. 2005;31:69–73.PubMedCrossRefGoogle Scholar
  24. 24.
    Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, Pisters PW, Evans DB. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg. 1998;85:611–617.PubMedCrossRefGoogle Scholar
  25. 25.
    Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg. 2006;10:1106–1115.PubMedCrossRefGoogle Scholar
  26. 26.
    Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, Jaeck D. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg. 2007;142:172–179.PubMedCrossRefGoogle Scholar
  27. 27.
    Takahashi S, Ogata Y, Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer. Br J Surg. 1994;81:1190–1193.PubMedCrossRefGoogle Scholar
  28. 28.
    Shimada K, Sano T, Sakamoto Y, Kosuge T. Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol. 2006;13:1569–1578.PubMedCrossRefGoogle Scholar
  29. 29.
    Makowiec F, Post S, Saeger HD, Senninger N, Becker H, Betzler M, Buhr HJ, Hopt UT. Current practice patterns in pancreatic surgery: results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German Advanced Surgical Treatment study group). J Gastrointest Surg. 2005;9:1080–1086.PubMedCrossRefGoogle Scholar
  30. 30.
    Howard TJ, Villanustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, McHenry L. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg. 2003;7:1089–1095.PubMedCrossRefGoogle Scholar
  31. 31.
    Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BSJ, Youssef BAM, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–517.PubMedCrossRefGoogle Scholar
  32. 32.
    Launois B, Stasik C, Bardaxoglou E, Meunier B, Campion JP, Greco L, Sutherland F. Who benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J Surg. 1999;23:926–929.PubMedCrossRefGoogle Scholar
  33. 33.
    Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238:84–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Seyama Y, Kubota K, Sano K, Takayama T, Kosuge T, Makuuchi M. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.PubMedCrossRefGoogle Scholar
  35. 35.
    Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg. 1996;171:170–174.PubMedCrossRefGoogle Scholar
  36. 36.
    Lang H, Sotiropoulos GC, Fruhauf NR, Domland M, Paul A, Kind EM, Malago M, Broelsch CE. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg. 2005;241:134–143.PubMedGoogle Scholar
  37. 37.
    Misuta K, Shimada H, Miura Y, Kunihiro O, Kubota T, Endo I, Sekido H, Togo S. The role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy. J Gastrointest Surg. 2005;9:245–253.PubMedCrossRefGoogle Scholar
  38. 38.
    Imaizumi T, Hanyu F, Harada N, Hatori T, Fukuda A. Extended radical Whipple resection for cancer of the pancreatic head: operative procedure and results. Dig Surg. 1998;15:299–307.PubMedCrossRefGoogle Scholar
  39. 39.
    Klempnauer J, Ridder GJ, Bektas H, Hatori T, Fukuda A. Extended resections of ductal pancreatic cancer—impact on operative risk and prognosis. Oncology. 1996;53:47–53.PubMedCrossRefGoogle Scholar
  40. 40.
    Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, Ogata Y, Hishinuma S, Asano T, Aikou T, Hosotani R, Maetani S. A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery. 2004;136:1003–1011.PubMedCrossRefGoogle Scholar
  41. 41.
    Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, Kato A, Nakamura S, Omoto H, Nakajima N, Kimura F, Suwa T. Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery. 1998;123:131–136.PubMedGoogle Scholar
  42. 42.
    Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S, Makuuchi M, Kawasaki S. Preoperative portal vein embolization: an audit of 84 patients. Hepatology. 1999;29:1099–1105.PubMedCrossRefGoogle Scholar
  43. 43.
    Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–372.PubMedCrossRefGoogle Scholar
  44. 44.
    Kondo S, Katoh H, Hirano S, Ebata T, Arai T, Nimura Y. Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer. Br J Surg. 2003;90:694–697.PubMedCrossRefGoogle Scholar
  45. 45.
    Sakaguchi S, Nakamura S. Surgery of the portal vein in resection of cancer of the hepatic hilus. Surgery. 1986;99:344–349.PubMedGoogle Scholar
  46. 46.
    Sakamoto Y, Kosuge T, Shimada K, Sano T, Ojima H, Yamamoto J, Yamasaki S, Takayama T, Makuuchi M. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery. 2005;137:396–402.PubMedCrossRefGoogle Scholar
  47. 47.
    Sasaki R, Takahashi M, Funato O, Nitta H, Murakami M, Kawamura H, Suto T, Kanno S, Saito K. Prognostic significance of lymph node involvement in middle and distal bile duct cancer. Surgery. 2001;129:677–683.PubMedCrossRefGoogle Scholar
  48. 48.
    Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Tajima H, Miwa K. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg. 1999;229:76–83.PubMedCrossRefGoogle Scholar
  49. 49.
    Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg. 2002;137:69–73.PubMedCrossRefGoogle Scholar
  50. 50.
    Tsukada K, Kurosaki I, Uchida K, Shirai Y, Oohashi Y, Yokoyama N, Watanabe H, Hatakeyama K. Lymph node spread from carcinoma of the gallbladder. Cancer. 1997;80:661–667.PubMedCrossRefGoogle Scholar
  51. 51.
    Kurosaki I, Tsukada K, Hatakeyama K, Muto T. The mode of lymphatic spread in carcinoma of the bile duct. Am J Surg. 1996;172:239–243.PubMedCrossRefGoogle Scholar
  52. 52.
    Kelley ST, Bloomston M, Serafini F, Carey LC, Karl RC, Zervos E, Goldin S, Rosemurgy P, Rosemurgy AS. Cholangiocarcinoma: advocate an aggressive operative approach with adjuvant chemotherapy. Am Surg. 2004;70:743–748.PubMedGoogle Scholar
  53. 53.
    Hong SM, Kim MJ, Cho H, Pi DY, Jo D, Yu E, Ro JY. Superficial vs. deep pancreatic parenchymal invasion in the extrahepatic bile duct carcinomas: a significant prognostic factor. Mod Pathol. 2005;18:969–975.PubMedCrossRefGoogle Scholar
  54. 54.
    Hasebe T, Konishi M, Iwasaki M, Endoh Y, Nakagohri T, Takahashi S, Kinoshita T, Ochiai A. Histological characteristics of tumor cells and stromal cells in vessels and lymph nodes are important prognostic parameters of extrahepatic bile duct carcinoma: a prospective study. Hum Pathol. 2005;36:655–664.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Isao Kurosaki
    • 1
  • Katsuyoshi Hatakeyama
    • 1
  • Masahiro Minagawa
    • 1
  • Daisuke Sato
    • 1
  1. 1.Division of Digestive and General SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan

Personalised recommendations