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Vascular Resection in Pancreatic Cancer Surgery: Survival Determinants

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Pancreaticoduodenectomy (PD) is the standard operation for cancer of the pancreatic head. To achieve complete tumor resection and, thus, improve long-term survival, venous resection of the portal or superior mesenteric vein with reconstruction has become routine for advanced pancreatic adenocarcinoma (PDAC). However, its clinical benefit still remains controversial. The aim of this study was to investigate morbidity, mortality, and survival of patients with advanced PDAC following PD with venous resection and to identify significant survival determinants.

Material and Methods

From October 2001 to December 2007, 488 patients with PDAC of the pancreatic head underwent PD at our department. Venous resection was performed in 110 patients (22.5%). Clinical data, surgical techniques, perioperative parameters, and histopathologic data were analyzed on a prospective database.

Results

Major venous reconstruction was accomplished through primary lateral venorrhaphy in 18 patients (16.3%), polytetrafluoroethylene grafting (n = 14, 12.7%), primary end-to-end anastomosis (n = 72, 65.5%), an autologous saphenous venous graft patch (n = 4, 4.6%) or a Goretex® patch (n = 2, 2.3%). In 78.1% histopathologic examination revealed cancer invasion of the vein, whereas the remainder had peritumoral inflammation extending to the vessel wall. Perioperative morbidity rate was 41.8%; and the mortality rate 3.6%. The 1-, 2-, and 3-year survival rates were 55.2%, 23.1%, and 14.4%, respectively. Operating time (>420 min) and advanced age (>70 years) were the only prognostic variables, which significantly diminished survival on multivariate analysis.

Conclusion

Resection of the superior mesenteric or portal vein to achieve macroscopic tumor clearance can be performed safely with acceptable operative morbidity and mortality. However, improved local clearance in these patients cannot achieve a favorable long-term survival for all patients because distant metastases or local recurrence is frequent.

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Authors and Affiliations

  1. Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Sascha A. Müller, Mark Hartel, Arianeb Mehrabi, Thilo Welsch, David J. Martin, Bruno M. Schmied & Markus W. Büchler

  2. Unit for Documentation and Statistics, Department of Surgery, University of Heidelberg, Heidelberg, Germany

    Ulf Hinz

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  1. Sascha A. Müller
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Correspondence to Markus W. Büchler.

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Müller, S.A., Hartel, M., Mehrabi, A. et al. Vascular Resection in Pancreatic Cancer Surgery: Survival Determinants. J Gastrointest Surg 13, 784–792 (2009). https://doi.org/10.1007/s11605-008-0791-5

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