Pancreaticoduodenectomy with vascular resection for borderline resectable periampullary malignancy

Abstract

Objective: To analyze whether pancreaticoduodenectomy with simultaneous mesenteric-portal venous (SMV-PV) resection is safe, and achieves acceptable oncologic outcome. Methods: Between January 2008 and March 2016, 442 patients underwent radical pancreaticoduodenectomy (PD) for ampullary/peri-ampullary malignancy. Forty-eight also had portal/SMV resection (group 1), and were compared to 394 that underwent PD only (group 2). Results: Median age, demographics and co-morbidities were similar between groups. There were 3 (7%) 60-day mortalities in group 1 and 19 (5%, p = 0.611) in group 2. Clinically significant Pancreatic fistula occurred in 7 patients in group 1 (9%) and 56 (14%) in group 2 (p = 0.661). Delayed post-pancreatectomy hemorrhage occurred in 3 patients (6%) in group 1, and 11 patients (3%) in group 2 (p = 0.51). Early thrombosis of the vascular reconstruction occurred in 1 patient (5%). This was treated successfully by surgical thrombectomy.Tumor histology, size, grade, and lymph node involvement, were similar in both groups. Microscopic vascular invasion was seen in 15 patients in group 1 (31%). R0 resection was achieved in 40 patients in group 1 (85%) and 343 (87%) in group 2 (p = NS).For patients with ductal adenocarcinoma, 1-and 3-year overall survival in group 1 were 63% and 15%, respectively and 71% and 25% in group 2 (p = NS). Conclusion: Simultaneous resection of tumor-involved SMV-PV is a safe approach with acceptable short and longterm outcome, when compared with that of standard pancreaticoduodenectomy.