Pancreaticoduodenectomy with Vascular Resection for Local Advanced Pancreatic Head Cancer: A Single Center Retrospective Study
Pancreaticoduodenectomy with vascular resection remains a controversial approach for patients with local advanced pancreatic head cancer for the lack of evidences of survival and quality of life benefits. The aim of this study was to evaluate whether patients of pancreatic head cancer benefit on quality of life, survival, and treatment cost from pancreaticoduodenectomy with vascular resection compared with palliative therapy.
Materials and Methods
Two hundred fourteen patients of pancreatic head cancer whose pancreatic head could not be dissected free from adjacent vascular were involved in this study. Eighty of these patients underwent pancreaticoduodenectomy with vascular resection, whereas other patients underwent palliative therapy.
Pancreaticoduodenectomy with artery resection offered worse outcomes on almost all aspects of quality of life and survival compared with palliative therapy. Pancreaticoduodenectomy with vein resection offered better 5-year survival compared with palliative therapy, whereas palliative therapy offered better quality of life after surgery.
Pancreaticoduodenectomy with artery resection is nonsensical on treatment of pancreatic head cancer with artery adhesion/invasion. As for patients with vein adhesion/invasion, pancreaticoduodenectomy with vein resection should be performed cautiously. When actual vein invasion is very possible to have taken place, the choice of treatment strategy should be considered carefully by the pancreatic surgeons.
KeywordsPancreatic neoplasms Neoplasm invasiveness Pancreatectomy Palliative care Drug therapy Brachytherapy
- 3.Makowiec F, Post S, Saeger HD, Senninger N, Becker H, Betzler M, et al. 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. (discussion 1086–1087). doi:10.1016/j.gassur.2005.07.020.PubMedCrossRefGoogle Scholar
- 11.Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK. The european organization for research and treatment of cancer. Approach to quality of life assessment: Guidelines for developing questionnaire modules. Eortc study group on quality of life. Qual Life Res 1993;2:287–295. doi:10.1007/BF00434800.PubMedCrossRefGoogle Scholar
- 17.Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej 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. doi:10.1097/00000658-199602000-00007.PubMedCrossRefGoogle Scholar
- 20.Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, et al. 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. doi:10.1046/j.1365-2168.1998.00641.x.PubMedCrossRefGoogle Scholar