Venous Resection in Pancreatic Cancer Surgery
Introduction: The clinical value of combined portal vein resection (PVR) during pancreatoduodenectomy (PD) for patients with pancreatic cancer has been discussed and many papers supporting this aggressive strategy have been published, however several controversies have remained insoluble. Recent progress in vascular surgical techniques enabled digestive surgeons to perform PVR safely.
Method: The indication of PVR is practically decided according to the intraoperative macroscopic findings and a type of PVR (wedge or segmental resection) is actually decided after detaching the uncinate process from the superior mesenteric artery during mesenteric root node dissection in many occasions. Reconstructive procedures after PVR have been developed and end-to-end anastomosis is commonly used. A transverse suture or an autologous vein patch closure should be used to prevent the portal vein stricture after wedge resection. An autologous vein graft (internal jugular vein, left renal vein, external iliac vein) is preferably used for interposition grafting because of low incidence of thrombosis than a synthetic graft.
Results: Although a PD with PVR is associated with longer operating time and more blood loss than a standard PD while providing R0 resection, no significant difference was found in morbidity and mortality between the two groups. Although different or similar survivals between the PD and PD with PVR groups were reported, depth of histological portal vein invasion and portographic findings of bilateral narrowing were poor prognostic factors.
Conclusions: Combined portal vein resection and reconstruction in R0 pancreatoduodenectomy provides acceptable morbidity, mortality and better survival than that of the unresected patients with locally advanced pancreatic cancer. PD with PVR should always be considered in case of pancreatic head cancer adherent to the portal vein in the absence of other contraindication for resection.
KeywordsPancreatic Cancer Portal Vein Superior Mesenteric Vein Advanced Pancreatic Cancer Portal Vein Invasion
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Fortner JG: Regional resection of cancer of the pancreas: a new surgical approach. Surgery 1973;73:307–320.PubMedGoogle Scholar
Fortner JG, Kim DK, Cubilla A, Turnbull A, Pahnke LD, Shils ME: Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg 1977;186:42–50.CrossRefPubMedGoogle Scholar
Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T: Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:215–220.CrossRefPubMedGoogle Scholar
Manabe T, Ohshio G, Baba N, Miyashita T, Asano N, Tamura K, Yamaki K, Nonaka A, Tobe T: Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 1989;64:1132–1137.CrossRefPubMedGoogle Scholar
Nakao A, Nonami T, Harada A, Kasuga T, Takagi H: Portal vein resection with a new antithrombogenic catheter. Surgery 1990;108:913–918.PubMedGoogle Scholar
Nagakawa T, Nagamori M, Futakami F, Tsukioka Y, Kayahara M, Ohta T, Ueno K, Miyazaki I: Results of extensive surgery for pancreatic carcinoma. Cancer 1996;77:640–645.CrossRefPubMedGoogle Scholar
Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S: Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg 1991;78:727–731.CrossRefPubMedGoogle Scholar
Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, El-Naggar AK, Fenoglio CJ, Lee JE, Evans DB: Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Ann Surg 1996;223:154–162.CrossRefPubMedGoogle Scholar
Smoot RL, Christein JD, Farnell MB: Durability of portal venous reconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg 2006;10:1371–1375.CrossRefPubMedGoogle Scholar
Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, Yoshidome H, Yoshitomi H, Furukawa K, Nozawa S: Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 2007;141:581–588.CrossRefPubMedGoogle Scholar
Harrison LE, Klimstra DS, Brennan MF: Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–349.CrossRefPubMedGoogle Scholar
Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J: Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 2004;28:602–608.PubMedGoogle Scholar
Siriwardana HP, Siriwardena AK: Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006;93:662.CrossRefPubMedGoogle Scholar
Hartel M, Niedergethmann M, Farag-Soliman M, Sturm JW, Richter A, Trede M, Post S: Benefit of venous resection for ductal adenocarcinoma of the pancreatic head. Eur J Surg 2002;168:707–712.CrossRefPubMedGoogle Scholar
Carrère N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, Ruszniewski P, Belghiti J: Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg 2006;30:1526–1535.CrossRefPubMedGoogle Scholar
Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, Jaeck D: Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg 2007;142:172–179.CrossRefPubMedGoogle Scholar
Schäfer M, Müllhaupt B, Clavien PA: Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg 2002;236:137–148.CrossRefPubMedGoogle Scholar
Takahashi S, Ogata Y, Tsuzuki T: Combined resection of the pancreas and portal vein for pancreatic cancer. Br J Surg 1994;81:1190–1193.CrossRefPubMedGoogle Scholar
Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, Fujii T: Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30:976–982.CrossRefPubMedGoogle Scholar
Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, Pisters PW, Evans DB: 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.CrossRefPubMedGoogle Scholar
Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S: Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 2003;186:149–53.CrossRefPubMedGoogle Scholar
Howard TJ, Villanustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, McHenry L: Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 2003;7:1089–1095.CrossRefPubMedGoogle Scholar
Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT: Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg 2006;10:1106–1115.CrossRefPubMedGoogle Scholar
Roder JD, Stein HJ, Siewert JR: Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996;171:170–175.CrossRefPubMedGoogle Scholar
Shimada K, Sano T, Sakamoto Y, Kosuge T: Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol 2006;13:1569–1578.CrossRefPubMedGoogle Scholar
Ishikawa O, Ohigashi H, Imaoka S, Furukawa H, Sasaki Y, Fujita M, Kuroda C Iwanaga T: Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 1992;215:231–236.CrossRefPubMedGoogle Scholar
Nakao A, Harada A, Nonami T, Kaneko T, Inoue S, Takagi H: Clinical significance of portal invasion by pancreatic head carcinoma. Surgery 1995;117:50–55.CrossRefPubMedGoogle Scholar
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