Does Portal-Superior Mesenteric Vein Invasion Still Indicate Irresectability for Pancreatic Carcinoma?

  • Giovanni Ramacciato
  • Paolo Mercantini
  • Niccolò Petrucciani
  • Valentina Giaccaglia
  • Giuseppe Nigri
  • Matteo Ravaioli
  • Matteo Cescon
  • Alessandro Cucchetti
  • Massimo Del Gaudio
Hepatobiliary and Pancreatic Tumors

Abstract

Background

Pancreatic carcinoma frequently infiltrates the portal vein or the superior mesenteric vein; pancreatectomy combined with portal vein/superior mesenteric vein resection represents a potentially curative treatment in these cases but is still a controversial procedure.

Methods

After performing a computerized Medline search, 12 series published during the last 8 years were selected, enrolling 399 patients who underwent pancreatectomy combined with portal vein/superior mesenteric vein resection for pancreatic carcinoma. Data were examined for information about indications, operation, adjuvant therapies, histopathology of resected specimens, perioperative results, and survival. Also, previous literature regarding the issue was extensively reviewed.

Results

Operative mortality and postoperative complication rates ranged from 0 to 7.7% and 16.7% to 54%, respectively. Median survival varied from 13 to 22 months; 5-year survival rate ranged from 9% to 18%.

Conclusions

The current literature suggests that portal vein/superior mesenteric vein resection combined with pancreatectomy is a safe and feasible procedure that increases the number of patients who undergo curative resection and, therefore, provides important survival benefits to selected groups of patients. This procedure should always be considered in case of suspected tumor infiltration of portal/superior mesenteric vein to achieve clear resection margins, in the absence of other contraindications for resection.

Keywords

Portal Vein Pancreatic Carcinoma National Comprehensive Cancer Network National Comprehensive Cancer Network Superior Mesenteric Vein 

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Giovanni Ramacciato
    • 1
  • Paolo Mercantini
    • 1
  • Niccolò Petrucciani
    • 1
  • Valentina Giaccaglia
    • 1
  • Giuseppe Nigri
    • 1
  • Matteo Ravaioli
    • 1
  • Matteo Cescon
    • 1
  • Alessandro Cucchetti
    • 1
  • Massimo Del Gaudio
    • 1
  1. 1.Azienda Ospedaliera Sant’Andrea, UOC Hepatobiliary and Pancreatic Surgery, II Faculty of MedicineUniversity of Rome “La Sapienza”RomeItaly

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