Abstract
Pancreaticoduodenectomy combined with portal vein resection is increasingly accepted as a viable treatment option for pancreatic carcinoma with suspected involvement of the portal vein.However, its clinical benefit remains controversial. This study evaluated the outcomes of pancreaticoduodenectomy with portal vein resection for pancreatic carcinoma in a group of Chinese patients operated on by a specialized team in a center with a low case volume of pancreatic cancer. The perioperative and long-term outcomes of 12 patients with portal vein resection for suspected involvement of the portal vein and 38 patients who underwent pancreaticoduodenectomy without portal vein resection during the same period were compared. In the former group, eight patients underwent segmental resection, and four patients underwent wedge resection of the portal vein. There were no significant differences in operative blood loss (median 0.8 vs. 0.8 liter, p = 0.313), hospital mortality (0% vs. 2.6%, p = 1.000), or operative morbidity (41.7% vs. 42.1%, p = 0.979) between the two groups. Patients who required portal vein resection had higher frequencies of microscopic lymphatic permeation (58.3% vs. 18.4%, p = 0.023) and vascular invasion (50.0% vs. 15.8%, p = 0.025). Long-term survival was comparable between patients with portal vein resection and those without it (median 19.5 vs. 20.7 months, p = 0.769). These findings suggest that pancreaticoduodenectomy combined with portal vein resection can be performed safely by a specialized team in a center with a low case volume of pancreatic carcinoma and that it may offer survival benefit in patients with suspected portal vein involvement.
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References
CJ Yeo JL Cameron KD Lillemoe et al. (1995) ArticleTitlePancreaticoduodenectomy for cancer of the head of the pancreas, 201 patients Ann. Surg. 221 721–733 Occurrence Handle1:STN:280:ByqA3Mvkt1Q%3D Occurrence Handle7794076
C Fernandez-del Castillo DW Rattner AL Warshaw (1995) ArticleTitleStandards for pancreatic resection in the 1990s Arch. Surg. 130 295–300 Occurrence Handle1:STN:280:ByqC1MvhvFE%3D Occurrence Handle7887797
JP Neoptolemos RC Russell S Bramhall et al. (1997) ArticleTitleLow mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units; UK Pancreatic Cancer Group Br. J. Surg. 84 1370–1376 Occurrence Handle10.1111/j.1365-2168.1997.00504.x Occurrence Handle1:STN:280:DyaK1c%2FislKlsA%3D%3D Occurrence Handle9361591
SR Bramhall WH Allum AG Jones et al. (1995) ArticleTitleTreatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study Br. J. Surg. 82 111–115 Occurrence Handle1:STN:280:ByqC1cjnt10%3D Occurrence Handle7881926
SF Sener A Fremgen HR Menck et al. (1999) ArticleTitlePancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database J. Am. Coll. Surg. 189 1–7 Occurrence Handle10.1016/S1072-7515(99)00075-7 Occurrence Handle1:STN:280:DyaK1MzivVWlsg%3D%3D Occurrence Handle10401733
WF Sindelar (1989) ArticleTitleClinical experience with regional pancreatectomy for adenocarcinoma of the pancreas Arch. Surg. 124 127–132 Occurrence Handle1:STN:280:BiaD1cjislI%3D Occurrence Handle2910241
JL Cameron DW Crist JV Sitzmann et al. (1991) ArticleTitleFactors influencing survival after pancreaticoduodenectomy for pancreatic cancer: factors influencing survival after pancreaticoduodenectomy for pancreatic cancer Am. J. Surg. 161 120–125 Occurrence Handle10.1016/0002-9610(91)90371-J Occurrence Handle1:STN:280:By6C3czjsl0%3D Occurrence Handle1987845
LE Harrison DS Klimstra MF Brennan (1996) ArticleTitleIsolated portal vein involvement in pancreatic adenocarcinoma: a contraindication for resection? Ann. Surg. 224 342–349 Occurrence Handle10.1097/00000658-199609000-00010 Occurrence Handle1:STN:280:BymH3cfitFM%3D Occurrence Handle8813262
GM Fuhrman SD Leach CA Staley et al. (1996) ArticleTitleRationale for en-bloc vein resection in the treatment of pancreatic adenocarcinoma adjacent to the superior mesenteric-portal vein confluence Pancreatic Tumor Study Group. Ann. Surg. 223 154–162 Occurrence Handle10.1097/00000658-199602000-00007 Occurrence Handle1:STN:280:BymC2srjs1A%3D
SD Leach JE Lee C Charnsangavej et al. (1998) ArticleTitleSurvival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head Br. J. Surg. 85 611–617 Occurrence Handle10.1046/j.1365-2168.1998.00641.x Occurrence Handle1:STN:280:DyaK1c3pslOhug%3D%3D Occurrence Handle9635805
JH Allema ME Reinders TM Gulik Particlevan et al. (1994) ArticleTitlePortal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head Br. J. Surg. 81 1642–1646 Occurrence Handle1:STN:280:ByqC38fmvFM%3D Occurrence Handle7827892
JD Roder HJ Stein JR Siewert (1996) ArticleTitleCarcinoma of the periampullary region: who benefits from portal vein resection? Am. J. Surg. 171 170–175 Occurrence Handle10.1016/S0002-9610(99)80094-4 Occurrence Handle1:STN:280:BymC2c3htVM%3D Occurrence Handle8554135
B Kremer I Vogel J Luttges et al. (1999) ArticleTitleSurgical possibilities for pancreatic cancer: extended resection Ann. Oncol. 10 S252–S256 Occurrence Handle10.1023/A:1008316531617
B Launois C Stasik E Bardaxoglou et al. (1999) ArticleTitleWho benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J. Surg. 23 926–929 Occurrence Handle10.1007/s002689900601 Occurrence Handle1:STN:280:DyaK1MzotVKqsQ%3D%3D Occurrence Handle10449822
RC Geenen ParticleVan FJ Kate Particleten LT Wit Particlede et al. (2001) ArticleTitleSegmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy Surgery 129 158–163 Occurrence Handle10.1067/msy.2001.110221 Occurrence Handle11174708
E Luque-de Leon GG Tsiotos B Balsiger et al. (1999) ArticleTitleStaging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate J. Gastrointestint. Surg. 3 111–118 Occurrence Handle10.1016/S1091-255X(99)80018-3 Occurrence Handle1:STN:280:DyaK1MzovVWrtQ%3D%3D
S Onoue T Katoh H Chigira et al. (2002) ArticleTitleCarcinoma of the head of the pancreas Hepatogastroenterology. 49 549–552 Occurrence Handle11995493
C Shibata M Kobari T Tsuchiya et al. (2001) ArticleTitlePancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas World J. Surg. 25 1002–1005 Occurrence Handle10.1007/s00268-001-0070-z Occurrence Handle1:STN:280:DC%2BD3MrisVGguw%3D%3D Occurrence Handle11571964
M Aramaki T Matsumoto T Etoh et al. (2003) ArticleTitleClinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma Hepatogastroenterology. 50 263–266 Occurrence Handle12630036
DS Longnecker MR Karagas TD Tosteson et al. (2000) ArticleTitleRacial differences in pancreatic cancer: comparison of survival and histologic types of pancreatic carcinoma in Asians, blacks, and whites in the United States Pancreas 21 338–343 Occurrence Handle10.1097/00006676-200011000-00003 Occurrence Handle1:STN:280:DC%2BD3M7itV2htQ%3D%3D Occurrence Handle11075987
M Dong Y Nio K Tamura et al. (2000) ArticleTitleKi-ras point mutation and p53 expression in human pancreatic cancer: a comparative study among Chinese, Japanese, and Western patients Cancer Epidemiol. Biomarkers Prev. 9 279–284 Occurrence Handle1:CAS:528:DC%2BD3cXisVKntbw%3D Occurrence Handle10750666
T Takada (1999) ArticleTitleSurgery for carcinoma of the pancreas in Japan: past, present and future aspects Digestion 60 114–119 Occurrence Handle10.1159/000051466 Occurrence Handle10026444
RT Poon ST Fan (2001) ArticleTitleOpinions and commentary on treating pancreatic cancer Surg. Clin. North Am. 81 625–636 Occurrence Handle1:STN:280:DC%2BD3Mvgslyiug%3D%3D Occurrence Handle11459276
H Friess J Kleeff L Fischer et al. (2003) ArticleTitleSurgical standard therapy for cancer of the pancreas Chirurg 74 183–190 Occurrence Handle10.1007/s00104-003-0620-z Occurrence Handle1:STN:280:DC%2BD3s7jt1aiuw%3D%3D Occurrence Handle12647074
S Tashiro R Uchino T Hiraoka et al. (1991) ArticleTitleSurgical indication and significance of portal vein resection in biliary and pancreatic cancer Surgery 109 481–487 Occurrence Handle1:STN:280:By6C1c%2FotFQ%3D Occurrence Handle1848949
O Ishikawa H Ohigashi S Imaoka et al. (1992) ArticleTitlePreoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein Ann. Surg. 215 231–236 Occurrence Handle1:STN:280:By2C1c7itl0%3D Occurrence Handle1543394
S Takahashi Y Ogata T Tsuzuki (1994) ArticleTitleCombined resection of the pancreas and portal vein for pancreatic cancer Br. J. Surg. 81 1190–1193 Occurrence Handle1:STN:280:ByqD2c7hsFU%3D Occurrence Handle7953357
A Nakao A Harada T Nonami et al. (1995) ArticleTitleClinical significance of portal invasion by pancreatic head carcinoma Surgery 117 50–55 Occurrence Handle1:STN:280:ByqC3cfnvVI%3D Occurrence Handle7809836
C Shibata M Kobari T Tsuchiya et al. (2001) ArticleTitlePancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas World J. Surg. 25 1002–1005 Occurrence Handle10.1007/s00268-001-0070-z Occurrence Handle1:STN:280:DC%2BD3MrisVGguw%3D%3D Occurrence Handle11571964
P Bachellier H Nakano E Oussoultzoglou et al. (2001) ArticleTitleIs pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am. J. Surg. 182 120–129 Occurrence Handle10.1016/S0002-9610(01)00686-9 Occurrence Handle1:STN:280:DC%2BD3Mrisl2isg%3D%3D Occurrence Handle11574081
M Kawada S Kondo S Okushiba et al. (2002) ArticleTitleReevaluation of the indications for radical pancreatectomy to treat pancreatic carcinoma: is portal vein infiltration a contraindication? Surg. Today 32 598–601 Occurrence Handle10.1007/s005950200108 Occurrence Handle12111516
M Aramaki T Matsumoto T Etoh et al. (2003) ArticleTitleClinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma Hepatogastroenterology. 50 263–266 Occurrence Handle12630036
T Nakagorhi T Kinoshita M Konishi et al. (2003) ArticleTitleSurvival benefits of portal vein resection for pancreatic cancer Am. J. Surg. 186 149–153 Occurrence Handle10.1016/S0002-9610(03)00173-9 Occurrence Handle12885608
Hong Kong Cancer Registry. Cancer incidence and mortality in Hong Kong 1997, Hong Kong, Hospital Authority, 1997
CC Boring TS Squires T Tong et al. (1994) ArticleTitleCancer statistics 1994 CA. Cancer J. Clin. 44 7–26 Occurrence Handle1:STN:280:ByuC3cfotlY%3D Occurrence Handle8281473
JA Sosa HM Bowman TA Gordon et al. (1998) ArticleTitleImportance of hospital volume in the overall management of pancreatic cancer Ann. Surg. 228 429–438 Occurrence Handle10.1097/00000658-199809000-00016 Occurrence Handle1:STN:280:DyaK1cvhtlymug%3D%3D Occurrence Handle9742926
JD Birkmeyer SR Finlayson AN Tosteson et al. (1999) ArticleTitleEffect of hospital volume on in-hospital mortality with pancreaticoduodenectomy Surgery 125 250–256 Occurrence Handle10.1067/msy.1999.95211 Occurrence Handle1:STN:280:DyaK1M7nsF2jtg%3D%3D Occurrence Handle10076608
DJ Gouma RC Geenen Particlevan TM Gulik Particlevan et al. (2000) ArticleTitleRates of complications and deaths after pancreaticoduodenectomy: risk factors and the impact of hospital volume Ann. Surg. 232 786–795 Occurrence Handle10.1097/00000658-200012000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2FltVymsg%3D%3D Occurrence Handle11088073
V Ho MJ Heslin (2003) ArticleTitleEffect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy Ann. Surg. 237 509–514 Occurrence Handle10.1097/00000658-200304000-00012 Occurrence Handle12677147
SM Strasberg JA Drebin NJ Soper (1997) ArticleTitleEvolution and current status of the Whipple procedure: an update for gastroenterologists Gastroenterology 113 983–994 Occurrence Handle1:STN:280:ByiH3svhtVM%3D Occurrence Handle9287993
CJ Yeo JL Cameron TA Sohn et al. (1997) ArticleTitleSix hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes Ann. Surg. 226 248–260 Occurrence Handle10.1097/00000658-199709000-00004 Occurrence Handle1:STN:280:ByiH2sbosFQ%3D Occurrence Handle9339931
CJ Yeo RA Abrams LB Grochow et al. (1997) ArticleTitlePancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival: a prospective, single-institution experience Ann. Surg. 225 621–636 Occurrence Handle10.1097/00000658-199705000-00018 Occurrence Handle1:STN:280:ByiA3snktlw%3D Occurrence Handle9193189
JH Klinkenbijl J Jeekel T Sahmoud et al. (1999) ArticleTitleAdjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group Ann. Surg. 230 776–784 Occurrence Handle10.1097/00000658-199912000-00006 Occurrence Handle1:STN:280:DC%2BD3c%2FotFKkug%3D%3D Occurrence Handle10615932
JP Neoptolemos JA Dunn DD Stocken et al. (2001) ArticleTitleAdjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial Lancet 358 1576–1585 Occurrence Handle10.1016/S0140-6736(01)06651-X Occurrence Handle1:CAS:528:DC%2BD3MXosFKmtro%3D Occurrence Handle11716884
VK Mehta G Fisher JA Ford et al. (2001) ArticleTitlePreoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas J. Gastrointest. Surg. 5 27–35 Occurrence Handle10.1016/S1091-255X(01)80010-X Occurrence Handle1:STN:280:DC%2BD3M3htlGrtg%3D%3D Occurrence Handle11309645
AR Sasson JP Hoffman EA Ross et al. (2002) ArticleTitleEn bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J. Gastrointest. Surg. 6 147–157 Occurrence Handle10.1016/S1091-255X(01)00063-4 Occurrence Handle11992799
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Poon, R., Fan, S., Lo, C. et al. Pancreaticoduodenectomy with En Bloc Portal Vein Resection for Pancreatic Carcinoma with Suspected Portal Vein Involvement. World J. Surg. 28, 602–608 (2004). https://doi.org/10.1007/s00268-004-7250-6
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DOI: https://doi.org/10.1007/s00268-004-7250-6