Skip to main content

Advertisement

SpringerLink
Log in

Comparison of end-to-end anastomosis and interposition graft during pancreatoduodenectomy with portal vein reconstruction for pancreatic ductal adenocarcinoma

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Many studies report that pancreatoduodenectomy (PD) with portal-superior mesenteric vein resection and reconstruction (PVR) is not a contraindication to extended tumor resection for pancreatic ductal adenocarcinoma. However, the clinical benefit of an interposition graft for PVR still remains controversial.

Methods

Between January 2001 and December 2017, 199 patients with pancreatic cancer underwent PD either with or without PVR, and their medical records were reviewed retrospectively, paying specific attention to the PVR methods and the long-term outcome.

Results

Among the 122 patients with PVR, 97 (79.5%) underwent end-to-end anastomosis and 25 (20.5%) had an interposition graft using the right external iliac vein (REIV). The 2-year and 5-year survival rates of the no-PVR group (54.2% and 30.8%, respectively) were longer than both the end-to-end anastomosis group (24.5% and 13.7%) and the interposition graft group (32% and 10.0%) (p < 0.001). However, there was no significant difference in the survival between the end-to-end anastomosis group and the interposition graft group (p = 0.963). A multivariate analysis indicated that the level of preoperative serum albumin < 3.5 g/dL (risk ratio (RR) 2.08, 95% confidence interval (CI) 1.26 to 3.43; p = 0.004), and postoperative adjuvant chemotherapy (RR 1.82, 95% CI 1.19 to 2.79; p = 0.006) were independently associated with overall survival after PVR.

Conclusions

An interposition graft using the REIV for PVR following PD is safe and effective. There was no significant prognostic difference between PD with end-to-end anastomosis and with an interposition graft in patients with pancreatic ductal adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Roch AM, House MG, Cioffi J, Ceppa EP, Zyromski NJ, Nakeeb A et al (2016) Significance of portal vein invasion and extent of invasion in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg 20(3):479–487

    Article  PubMed  Google Scholar 

  2. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310(14):1473–1481

    Article  CAS  PubMed  Google Scholar 

  3. Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, Kaneoka Y, Shimizu Y, Nakamori S, Sakamoto H, Morinaga S, Kainuma O, Imai K, Sata N, Hishinuma S, Ojima H, Yamaguchi R, Hirano S, Sudo T, Ohashi Y (2016) JASPAC 01 Study Group. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388(10041):248–257

    Article  CAS  Google Scholar 

  4. Bell R, Ao BT, Ironside N, Bartlett A, Windsor JA, Pandanaboyana S (2017) Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: impact on margin status and survival. Surg Oncol 26(1):53–62

    Article  PubMed  Google Scholar 

  5. Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I (2016) Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 103(3):179–191

    Article  CAS  Google Scholar 

  6. Murakami Y, Satoi S, Motoi F, Sho M, Kawai M, Matsumoto I (2015) Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg 102(7):837–846

    Article  CAS  PubMed  Google Scholar 

  7. Klein F, Berresheim F, Felsenstein M, Malinka T, Pelzer U, Denecke T, Pratschke J, Bahra M (2018) Routine portal vein resection for pancreatic adenocarcinoma shows no benefit in overall survival. Eur J Surg Oncol 44(7):1094–1099

    Article  PubMed  Google Scholar 

  8. Snyder RA, Prakash LR, Nogueras-Gonzalez GM, Kim MP, Aloia TA, Vauthey JN, Lee JE, Fleming JB, Katz MHG, Tzeng CWD (2018) Vein resection during pancreaticoduodenectomy for pancreatic adenocarcinoma: patency rates and outcomes associated with thrombosis. J Surg Oncol 117(8):1648–1654

    Article  PubMed  Google Scholar 

  9. Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK, Schurr PG, Liebl L, Thieltges S, Gawad KA, Schneider C, Izbicki JR (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 247(2):300–309

    Article  PubMed  Google Scholar 

  10. Wang C, Wu H, Xiong J, Zhou F, Tao J, Liu T, Zhao G, Gou S (2008) Pancreaticoduodenectomy with vascular resection for local advanced pancreatic head cancer: a single center retrospective study. J Gastrointest Surg 12(12):2183–2190

    Article  PubMed  Google Scholar 

  11. Ravikumar R, Sabin C, Abu Hilal M, Al-Hilli A, Aroori S, Bond-Smith G et al (2017) Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Br J Surg 104(11):1539–1548

    Article  CAS  Google Scholar 

  12. Society JP (ed) (2003) General rules for the study of pancreatic cancer, 2nd edn. Kanehara, Tokyo

    Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  14. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA et al (2014) International Study Group of Pancreatic Surgery. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988

    Article  Google Scholar 

  15. Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ et al (1998) Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg 85(5):611–617

    Article  CAS  Google Scholar 

  16. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD et al (2001) Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 182(2):120–129

    Article  CAS  PubMed  Google Scholar 

  17. Shimoda M, Mori S, Kita J, Sawada T, Kubota K (2013) Results of pancreaticoduodenectomy with portal or superior mesenteric vein resection for locally advanced pancreatic head cancer. Hepatogastroenterology 60(128):2094–2098

    PubMed  Google Scholar 

  18. Ramacciato G, Mercantini P, Petrucciani N, Giaccaglia V, Nigri G, Ravaioli M, Cescon M, Cucchetti A, del Gaudio M (2009) Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 16(4):817–825

    Article  PubMed  Google Scholar 

  19. Kaneoka Y, Yamaguchi A, Isogai M (2009) Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery 145(4):417–425

    Article  PubMed  Google Scholar 

  20. Takahashi S, Ogata Y, Aiura K, Kitajima M, Hiramatsu K (2000) Combined resection of the portal vein for pancreatic cancer: preoperative diagnosis of invasion by portography and prognosis. Hepatogastroenterology 47(32):545–549

    CAS  PubMed  Google Scholar 

  21. Boggi U, Del Chiaro M, Croce C, Vistoli F, Signori S, Moretto C et al (2009) Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery 146(5):869–881

    Article  PubMed  Google Scholar 

  22. Han SS, Park SJ, Kim SH, Cho SY, Kim YK, Kim TH, Lee SA, Woo SM, Lee WJ, Hong EK (2012) Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer. Pancreas 41(1):102–106

    Article  CAS  PubMed  Google Scholar 

  23. Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF, Deshpande V, Hong TS, Kwak EL, Lauwers GY, Ryan DP, Wargo JA, Lillemoe KD, Ferrone CR (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg 257(4):731–736

    Article  Google Scholar 

  24. Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfeld C, Jäger D, Schirmacher P, Hackert T, Büchler MW (2017) Pancreatic cancer surgery: the new R-status counts. Ann Surg 265(3):565–573

    Article  PubMed  Google Scholar 

  25. Delpero JR, Jeune F, Bachellier P, Regenet N, Le Treut YP, Paye F et al (2017) Prognostic value of resection margin involvement after pancreaticoduodenectomy for ductal adenocarcinoma: updates from a French prospective multicenter study. Ann Surg 266(5):787–796

    Article  PubMed  Google Scholar 

  26. Marchegiani G, Andrianello S, Malleo G, De Gregorio L, Scarpa A, Mino-Kenudson M et al (2017) Does size matter in pancreatic cancer?: reappraisal of tumour dimension as a predictor of outcome beyond the TNM. Ann Surg 266(1):142–148

    Article  PubMed  Google Scholar 

  27. Butturini G, Stocken DD, Wente MN, Jeekel H, Klinkenbijl JH, Bakkevold KE, Takada T, Amano H, Dervenis C, Bassi C, Büchler MW, Neoptolemos JP, Pancreatic Cancer Meta-Analysis Group (2008) Pancreatic Cancer Meta-Analysis Group. Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 143(1):75–83

    Article  PubMed  Google Scholar 

  28. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW (2017) European Study Group for Pancreatic Cancer. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 389(10073):1011–1024

    Article  CAS  PubMed  Google Scholar 

  29. Sinn M, Bahra M, Liersch T, Gellert K, Messmann H, Bechstein W, Waldschmidt D, Jacobasch L, Wilhelm M, Rau BM, Grützmann R, Weinmann A, Maschmeyer G, Pelzer U, Stieler JM, Striefler JK, Ghadimi M, Bischoff S, Dörken B, Oettle H, Riess H (2017) CONKO-005: adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: a multicenter randomized phase III trial. J Clin Oncol 35(29):3330–3337

    Article  CAS  PubMed  Google Scholar 

  30. Hendifar A, Osipov A, Khanuja J, Nissen N, Naziri J, Yang W, Li Q, Tuli R (2016) Influence of body mass index and albumin on perioperative morbidity and clinical outcomes in resected pancreatic adenocarcinoma. PLoS One 11(3):e0152172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Wang F, Arianayagam R, Gill A, Puttaswamy V, Neale M, Gananadha S, Hugh TJ, Samra JS (2012) Grafts for mesenterico-portal vein resections can be avoided during pancreatoduodenectomy. J Am Coll Surg 215(4):569–579

    Article  PubMed  Google Scholar 

  32. Zhang J, Qian HG, Leng JH, Cui M, Qiu H, Zhou GQ, Wu JH, Yang Y, Hao CY (2009) Long mesentericoportal vein resection and end-to-end anastomosis without graft in pancreaticoduodenectomy. J Gastrointest Surg 13(8):1524–1528

    Article  PubMed  Google Scholar 

  33. Dua MM, Tran TB, Klausner J, Hwa KJ, Poultsides GA, Norton JA, Visser BC (2015) Pancreatectomy with vein reconstruction: technique matters. HPB (Oxford) 17(9):824–831

    Article  PubMed Central  Google Scholar 

  34. Ochiai T, Masuda T, Nishizawa M, Ito H, Igari K, Aihara A, Kumagai Y, Iida M, Odajima H, Arii S, Yamazaki S (2011) Curative resection of a huge malignant pancreatic endocrine tumor by pancreatoduodenectomy with portal and superior mesenteric vein resection and reconstruction using the right ovarian vein: report of a case. Surg Today 41(9):1260–1265

    Article  PubMed  Google Scholar 

  35. Yamamoto Y, Sakamoto Y, Nara S, Ban D, Esaki M, Shimada K, Kosuge T (2009) Reconstruction of the portal and hepatic veins using venous grafts customized from the bilateral gonadal veins. Langenbeck's Arch Surg 394(6):1115–1121

    Article  Google Scholar 

  36. Lee DY, Mitchell EL, Jones MA, Landry GJ, Liem TK, Sheppard BC, Billingsley KG, Moneta GL (2010) Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy. J Vasc Surg 51(3):662–666

    Article  PubMed  Google Scholar 

  37. Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM, Sarmiento JM (2010) Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg 211(3):316–324

    Article  PubMed  Google Scholar 

  38. Stauffer JA, Dougherty MK, Kim GP, Nguyen JH (2009) Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg 96(3):247–252

    Article  CAS  PubMed  Google Scholar 

  39. Kaneoka Y, Maeda A, Sugimoto M, Isogai M, Ishibashi H (2013) Quality of life and the venous function of the lower limb after harvest of autologous external iliac vein grafts: a clinical follow-up study. Surg Today 43(11):1254–1260

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan

    Fumihiro Terasaki, Yasuyuki Fukami, Atsuyuki Maeda, Yuichi Takayama, Takamasa Takahashi, Masahito Uji & Yuji Kaneoka

Authors
  1. Fumihiro Terasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuyuki Fukami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsuyuki Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichi Takayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takamasa Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masahito Uji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Kaneoka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuyuki Fukami.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terasaki, F., Fukami, Y., Maeda, A. et al. Comparison of end-to-end anastomosis and interposition graft during pancreatoduodenectomy with portal vein reconstruction for pancreatic ductal adenocarcinoma. Langenbecks Arch Surg 404, 191–201 (2019). https://doi.org/10.1007/s00423-019-01749-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-019-01749-2

Keywords

Search

Navigation