Skip to main content
SpringerLink
Log in

Pancreaticoduodenectomy with Mesentericoportal Vein Resection for Adenocarcinoma of the Pancreatic Head

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The value of mesentericoportal vein resection (VR) associated with pancreaticoduodenectomy (PD) for pancreatic-head adenocarcinoma still remains controversial.

Methods

From 1989 to 2003, 45 consecutive patients with pancreatic-head adenocarcinoma underwent PD with mesentericoportal VR due to intraoperative macroscopic involvement of the superior mesenteric or portal vein (VR+ group). They were compared with 88 patients who underwent PD for adenocarcinoma without VR over the same time period (VR− group) and matched for age, American Society of Anesthesiologists (ASA) score, pathological diagnosis, and nodal involvement. Preoperative features, intraoperative parameters, postoperative course, and survival were compared between the VR+ group and VR− group. Factors that may influence survival were determined by univariate and multivariate analyses.

Results

Mortality, morbidity, and mean hospital stay did not differ between the two groups (VR+ 4.4%, 56%, and 22.6 days, respectively; VR− 5.7%, 64%, 24.6 days, respectively). In the group VR+, vein invasion was histologically proven in 29 (64%) patients. Three-year global survival and 3-year disease-free survival did not differ between the two groups: VR+ 22% and 14%, respectively; VR− 25% and 21%, respectively (log-rank: P = 0.69 and P = 0.39, respectively). Neither VR nor histologically proven vein involvement significantly impacted survival duration. On multivariate analysis, tumor-free margin was the most important prognostic factor.

Conclusions

Vein resection during PD can be performed safely. Patients with adenocarcinoma who require VR during PD have a survival not different from that of patients who undergo standard PD. Macroscopic isolated mesentericoportal vein involvement is not a contraindication for PD in patients with adenocarcinoma provided disease-free margins can be obtained.

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

Figure 1.
Figure 2.

Similar content being viewed by others

References

  1. Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455–465

    Article  PubMed  CAS  Google Scholar 

  2. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–257

    Article  PubMed  CAS  Google Scholar 

  3. Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–299

    PubMed  CAS  Google Scholar 

  4. Neoptolemos JP, Russell RC, Bramhall S, et al. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg 1997;84:1370–1376

    Article  PubMed  CAS  Google Scholar 

  5. Yeo CJ, Sohn TA, Cameron JL, et al. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 1998;227:821–831

    Article  PubMed  CAS  Google Scholar 

  6. Bramhall SR, Allum WH, Jones AG, et al. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995;82:111–115

    PubMed  CAS  Google Scholar 

  7. Sener SF, Fremgen A, Menck HR, et al. Pancreatic 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 1999;189:1–7

    Article  PubMed  CAS  Google Scholar 

  8. Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–347

    Article  PubMed  CAS  Google Scholar 

  9. Fuhrman G, Leach S, Staley C, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 1996;223:154–162

    Article  PubMed  CAS  Google Scholar 

  10. Leach S, Lee J, Charnsangavej C, et al. 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

    Article  PubMed  CAS  Google Scholar 

  11. Bachellier P, Nakano H, Oussoultzoglou P, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 2001;182:120–129

    Article  PubMed  CAS  Google Scholar 

  12. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–950

    Article  PubMed  Google Scholar 

  13. Allema J, Reinders M, van Gulik T, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. Br J Surg 1994;81:1642–1646

    PubMed  CAS  Google Scholar 

  14. Roder J, Stein H, Siewert J. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996;171:170–174

    Article  PubMed  CAS  Google Scholar 

  15. Launois B, Stasik C, Bardaxoglou E, et al. Who benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J Surg 1999;23:926–929

    Article  PubMed  CAS  Google Scholar 

  16. van Geenen RC, ten Kate FJ, de Wit LT, et al. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery 2001;129:158–163

    Article  PubMed  Google Scholar 

  17. Capussotti L, Massucco P, Ribero D, et al. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 2003;138:1316–1322

    Article  PubMed  Google Scholar 

  18. Miettinen OS. Individual matching with multiple controls in the case of all-or-none responses. Biometrics 1969;25:339–355

    Article  PubMed  CAS  Google Scholar 

  19. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: part 2: randomized controlled trial evaluating survival, morbidity and mortality. Ann Surg 2002;236:355–368

    Article  PubMed  Google Scholar 

  20. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy 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

    Article  PubMed  CAS  Google Scholar 

  21. Varty PP, Yamamoto H, Farges O, et al. Early retropancreatic dissection during pancreaticoduodenectomy. Am J Surg 2005;189:488–491

    Article  PubMed  Google Scholar 

  22. Munoz-Bongrand N, Sauvanet A, Denys A, et al. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 2004;199:198–203

    Article  PubMed  Google Scholar 

  23. Hamilton SR, Aaltonen LA. Pathology and genetics of tumours of the digestive system. Washington, DC, IARC Press, 2000

    Google Scholar 

  24. (UICC) IUAC. TNM: classification of malignant tumours. 6th ed. Ed. New York, NY, Wiley, 2002

    Google Scholar 

  25. 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 2004;28:602–608

    Article  PubMed  Google Scholar 

  26. Andersen HB, Baden H, Brahe NE, Burcharth F. Pancreaticoduodenectomy for periampullary adenocarcinoma. J Am Coll Surg 1994;179:545–552

    PubMed  CAS  Google Scholar 

  27. Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant 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 1999;230:776–782

    Article  PubMed  CAS  Google Scholar 

  28. Neoptolemos JP, Dunn JA, Stocken DD, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 2001;358:1576–1585

    Article  PubMed  CAS  Google Scholar 

  29. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210

    Article  PubMed  CAS  Google Scholar 

  30. Stojadinovic A, Brooks A, Hoos A, et al. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 2003;196:954–964

    Article  PubMed  Google Scholar 

  31. Koniaris LG, Schoeniger LO, Kovach S, et al. The quick, no-twist, no-kink portal confluence reconstruction. J Am Coll Surg 2003;196:490–494

    Article  PubMed  Google Scholar 

  32. Clavien P, Rudiger H. A simple technique of portal vein resection and reconstruction during pancreaticoduodenectomy. J Am Coll Surg 1999;189:629–634

    Article  PubMed  CAS  Google Scholar 

  33. Howard TJ, Villanustre N, Moore SA, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 2003;7:1089–1095

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Digestive Surgery (NC, AS, DG, RK, JB), Radiology (MPV), Pathology (AC), and Gastroenterology (PR), AP-HP, Hôpital Beaujon, University Paris VII, 100 Bd du Général Leclerc, 92118, Clichy Cedex, France

    Nicolas Carrère MD, Alain Sauvanet MD, Diane Goere MD, Reza Kianmanesh MD, PhD, Marie-Pierre Vullierme MD, Anne Couvelard MD, PhD, Philippe Ruszniewski MD & Jacques Belghiti MD

Authors
  1. Nicolas Carrère MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alain Sauvanet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diane Goere MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reza Kianmanesh MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie-Pierre Vullierme MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne Couvelard MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philippe Ruszniewski MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jacques Belghiti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alain Sauvanet MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carrère, N., Sauvanet, A., Goere, D. et al. Pancreaticoduodenectomy with Mesentericoportal Vein Resection for Adenocarcinoma of the Pancreatic Head. World J. Surg. 30, 1526–1535 (2006). https://doi.org/10.1007/s00268-005-0784-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0784-4

Keywords

Search

Navigation