Pancreaticoduodenectomy with Mesentericoportal Vein Resection for Adenocarcinoma of the Pancreatic Head

• Published in: World journal of surgery Vol. 30; no. 8; pp. 1526 - 1535
• Main Authors: Carrère, Nicolas, Sauvanet, Alain, Goere, Diane, Kianmanesh, Reza, Vullierme, Marie‐Pierre, Couvelard, Anne, Ruszniewski, Philippe, Belghiti, Jacques
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01.08.2006; Springer; Springer Nature B.V
• Subjects: Adenocarcinoma - surgery; Bile Duct Adenocarcinoma; Bile Duct Transection; Biological and medical sciences; Common Bile Duct Neoplasms - surgery; Female; General aspects; Humans; Male; Medical sciences; Mesenteric Root; Mesenteric Veins - surgery; Middle Aged; Pancreatic Fistula; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Portal Vein - surgery; Prognosis; Retroperitoneal Margin; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Duodenum; Surgical resection; Pancreatic head; Malignant tumor; Medicine; Treatment; Surgery; Pancreas cancer; Digestive diseases; Vein; Pancreas adenocarcinoma; Pancreatic disease; Pancreatoduodenectomy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-005-0784-4

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.