Journal of Gastrointestinal Surgery

, Volume 14, Issue 9, pp 1442–1452

Extended Pancreaticoduodenectomy with Vascular Resection for Pancreatic Cancer: A Systematic Review

Review Article

Abstract

Objectives

This systematic review objectively evaluates the safety and outcomes of extended pancreaticoduodenectomy with vascular resection for pancreatic cancer involving critical adjacent vessels namely the superior mesenteric-portal veins, hepatic artery, superior mesenteric artery, and celiac axis.

Methods

Electronic searches were performed on two databases from January 1995 to August 2009. The end points were: firstly, to evaluate the safety through reporting the mortality rate and associated complications and, secondly, the outcome by reporting the survival after surgery. This was synthesized through a narrative review with full tabulation of results of all included studies.

Results

Twenty-eight retrospective studies comprising of 1,458 patients were reviewed. Vein thrombosis and arterial involvement were reported as contraindications to surgery in 62% and 71% of studies, respectively. The median mortality rate was 4% (range, 0% to 17%). The median R0 and R1 rates were 75% (range, 14% to 100%) and 25% (range, 0% to 86%), respectively. In high volume centers, the median survival was 15 months (range, 9 to 23 months). Nine of 10 (90%) studies comparing the survival after extended pancreaticoduodenectomy with vascular resection versus standard pancreaticoduodenectomy reported statistically similar (p > 0.05) survival outcomes. Undertaking vascular resection was not associated with a poorer survival.

Conclusions

The morbidity, mortality, and survival outcome after undertaking extended pancreaticoduodenectomy with vascular resection for pancreatic cancer with venous involvement and/or limited arterial involvement is acceptable in the setting of an expert referral center and should not be a contraindication to a curative surgery.

Keywords

Morbidity Mortality Postoperative complication Pancreatic cancer Pancreaticoduodenectomy Whipple’s operation Roux-en-Y anastomosis Vascular procedures 

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of New South Wales, St George HospitalSydneyAustralia

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