Abstract
Pancreaticoduodenectomy is often avoided in patients with portal or superior mesenteric venous involvement due to the perception that venous resection is complex, morbid, and carries a poor longterm survival. Our recent experience using state-of-the-art imaging and strict resection criteria show that venous reconstruction increases operative time, transfusion requirements, intensive care unit stay, and total hospital length of stay, but has no significant impact on operative morbidity rates, mortality rates, or the incidence of positive histologic margins. Kalpan-Meier life table analysis shows similar survival curves when compared to a contemporary cohort of patients who do not undergo venous reconstruction.
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References
Cancer Statistics, 2003. CA: A cancer Journal for Physicians 2003;53:7.
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.
Schäfer M, Müllhaupt B, Clavien P-A. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg 2002;236:137–148.
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.
Sindelar W. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 1989;124:127–132.
van Geenen RCI, ten Kate FJW, de Wit LT, vanGulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreaticoduodenectomy. Surgery 2001;129:158–163.
Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Boudjema K, Wolf P, Jaeck D. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile?. Am J Surg 2001;182:120–129.
Dewitt JM, Devereaux B, Ciaccia D, Imperiale T, Howard TJ, Madura JA, Aisen A, Kopecky K, Wass J, Cummings O, Chriswell M, Overton J, Lane K, Sherman S. Prospective comparison of endoscopic ultrasound (EUS) and dual-phase helical computed tomography (DPHCT) for determination of resectability of pancreatic malignancy. Gastroenterology 2002;122:A685.
Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathological analysis of nodal involvement and plexus invasion. Surgery 1995;117:616–623.
Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978;146:959–962.
Harrison LE, Brennan MF. Portal vein involvement in pancreatic cancer: A sign of unresectability. Adv Surg 1998;31:375–395.
Fortner JG. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg 1984;199:418–425.
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.
Crist DW, Cameron JL. The current status of the Whipple operation for periampullary carcinoma. Adv Surg 1992;25:21–49.
Nakao A, Kaneko T, Takeda S, Inoue S, Harada A, Nomoto S, Ekmel T, Yamashita K, Hatsuno T. The role of extended radical operation for pancreatic carcinoma. Hepatogastroenterology 2001;48:949–952.
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. IntJ Pancreatol 1991;10:105–111.
Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection. Am J Surg 1996;171:170–175.
Nagakawa T, Konishi I, Ueno K, Ohta T, Kayahara M, Miyazaki I. Extended radical pancreatectomy for carcinoma of the head of the pancreas. Hepatogastroenterology 1998; 45:849–854.
Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K, Michelassi F. Standard versus extended lymphadenectomy associated with pancreaticoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998;228:508–517.
Yeo CJ, Cameron JL, Sohn TA, Coleman J, Santer PK, Hruban RH, Pitt HA, Lillemoe KD. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 1999;229:613–622.
Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Longterm survival after resection for ductal adenocarcinoma of the pancreas: Is it really improving? Ann Surg 1995;221:59–66.
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Howard, T.J., Villanustre, N., Moore, S.A. et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 7, 1089–1095 (2003). https://doi.org/10.1016/j.gassur.2003.07.010
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DOI: https://doi.org/10.1016/j.gassur.2003.07.010