Vascular Resection for Pancreatic Cancer

Vascular resection for adenocarcinoma of the pancreas is one of the most controversial issues in the management of pancreatic cancer (1). Pancreaticoduodenectomy (PD) is a complicated and challenging operation; vascular resection and reconstruction adds to this complexity. The potential for high morbidity in patients who undergo PD, the poor prognosis of most patients with pancreatic cancer, and a frequent lack of familiarity with appropriate indications as well as the technical aspects of vascular resection and reconstruction have contributed to making surgeons reluctant to perform this procedure in the context of PD.

Resection and reconstruction of the superior mesenteric vein (SMV) for pancreatic cancer was first performed in 1951 by Moore at the University of Minnesota ( 2 ). In 1973, Fortner proposed the concept of “regional pancreatectomy,” which entailed en bloc pancreatic and peripancreatic resection along with major vascular resection and reconstruction. However, subsequent evaluation of this approach by Fortner and others failed to demonstrate any survival benefit to this radical approach ( 3, 4 ).