Vascular resection in pancreatic adenocarcinoma with portal or superior mesenteric vein invasion

Abstract

Aim: To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection (SMV/PVR) in relation to resection length.

Methods: We evaluated 118 patients who underwent the Whipple operation for pancreatic adenocarcinoma at our Department of Hepatobiliary Pancreatic Surgery between 2005 and 2010. Fifty-eight of these patients were diagnosed with microscopic PV/SMV invasion by frozen-section examination and underwent SMV/PVR. In 28 patients, the length of SMV/PVR was ≤ 3 cm. In the other 30 patients, the length of SMV/PVR was > 3 cm. Clinical and survival data were analyzed.

Results: SMV/PVR was performed successfully in 58 patients. There was a significant difference between the two groups (SMV/PVR ≤ 3 cm and SMV/PVR > 3 cm) in terms of the mean survival time (18 mo vs 11 mo) and the overall 1- and 3-year survival rates (67.9% and 14.3% vs 41.3% and 5.7%, P < 0.02). However, there was no significant difference in age (64 years vs 58 years, P = 0.06), operative time (435 min vs 477 min, P = 0.063), blood loss (300 mL vs 383 mL, P = 0.071) and transfusion volume (85.7 mL vs 166.7 mL, P = 0.084) between the two groups.

Conclusion: Patients who underwent the Whipple operation with SMV/PVR ≤ 3 cm had better long-term survival than those with > 3 cm resection.

Keywords: Pancreatic adenocarcinoma; Vascular resection; Whipple operation.

Figure 1

Survival of patients with portal vein resection. A: Patients with superior mesenteric vein/portal vein resection (SMV/PVR) ≤ 3 cm (Dotted line, n = 28) had more risk factors compared with patients with > 3 cm resection (solid line, n = 30); B: SMV/PVR ≤ 3 cm (Dotted line, n = 28) was significantly better than > 3 cm resection (solid line, n = 30).