Postoperative Morbidity and Long-term Survival After Pancreaticoduodenectomy With Superior Mesenterico−Portal Vein Resection

Riediger, Hartwig; Makowiec, Frank; Fischer, Eva; Adam, Ulrich; Hopt, Ulrich T.

doi:10.1016/j.gassur.2006.04.002

Cited by 156 publications

(134 citation statements)

References 33 publications

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“…Large series with radical surgical resection showed that surgical morbidity and mortality rates are comparable to standard pancreatic head resections [38][39][40]. Comparable complication rates between standard pancreaticoduodenectomy (PD) and pancreaticoduodenectomy with vascular resection (PDVR) were reported by some studies [12,13]. Tseng et al from the MD Anderson Centre, found no survival difference in patients undergoing PD and PDVR [29].…”

Section: Outcomementioning

confidence: 99%

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The Role of Vascular Resection in Pancreatic Cancer Treatment

Vladov¹,

Takorov²,

Lukanova³

2017

Challenges in Pancreatic Pathology

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Currently, porto-mesenteric vein resection is a standard procedure at high-volume pancreatic centers. Experience in vascular surgery is indispensable for a modern pancreatic surgeon. Nowadays, only arterial resections still are a controversial issue. Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery, and superior mesenteric artery (SMA) have been reported, although in small case series. An overview of the historical and contemporary methods for surgical management of superior mesenteric/portal vein involvement as well as arterial involvement by pancreatic cancer is presented. We compare the data from the literature with our data based on the examination and long-term follow-up of more than 300 radical pancreatic resections. Seventy-two of the presented patients underwent pancreatic resection with simultaneous vascular resection-SMPV in 65 cases (44 with resection of the portal vein, 15 with resection of the superior mesenteric vein, 6 with resection of the portomesenterial confluence), arterial in 2 and partial resections of IVC in 5 cases. Combined vascular resections were done in three cases. Both groups PVR and PR showed similarly close results in complication rates, mortality, and morbidity. Three and 5 years survival rates were 42 and 38% in PD group and 28 and 19% in the PVR group. The vascular resection must be performed only upon carefully selected patients with data for presence of resectable tumors or tumors with borderline resectability from the preoperative imaging studies. The prompt management of pancreatic cancer with vascular involvement should involve multidisciplinary consultation in high-volume centers.

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Section: Outcomementioning

confidence: 99%

“…There are numerous reports on portal vein resection in locally advanced pancreatic cancer in the last decade, but still the results are conflicting [10][11][12][13][14][15][16][17].…”

Section: Historymentioning

confidence: 99%

The Role of Vascular Resection in Pancreatic Cancer Treatment

Vladov¹,

Takorov²,

Lukanova³

2017

Challenges in Pancreatic Pathology

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“…After pancreatoduodenectomy (PD) for pancreatic head adenocarcinoma, perioperative morbidity and long-term survival in patients with portal vein resection is similar to patients without need of portral vein resection (7)(8)(9)(10)21). In the case of tumor adherence or venous infiltration, a combined resection of the pancreatic head and the vein should always be considered in the absence of other contraindications for resection (7)(8)(9)(10).…”

Section: Scope Of Current Opinionsmentioning

confidence: 99%

“…In the case of tumor adherence or venous infiltration, a combined resection of the pancreatic head and the vein should always be considered in the absence of other contraindications for resection (7)(8)(9)(10). The author believes that PVR should become a standard procedure during PD.…”

Section: Scope Of Current Opinionsmentioning

confidence: 99%

Portal Vein Resection During Pancreatectomy for Pancreatic Head Adenocarcinoma. Scope of Current Opinions and own Experiences

Łaski¹,

Hać²,

Śledziński³

2014

Polish Journal of Surgery

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“…There are no prospective randomized trials comparing pancreatectomy with and without VnR. Most retrospective studies demonstrate that while VnR is associated with longer operative times and larger blood loss, the morbidity and mortality of pancreatectomy with VnR is similar to those of pancreatectomy alone (Table 3) [42][43][44][45][46][47][48][49][50][51][52][53][54]. There was a high incidence of venous invasion (50%-82%) among patients who underwent VnR.…”

Section: Portal/mesenteric Vascular Resectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the evidence in favor of and against the role of surgical resection in the management of pancreatic adenocarcinoma.2. Explain how the components of an extended pancreatectomy, including total pancreatectomy, extended lymph node dissection, and major intestinal arterial resection, do not improve survival above what is provided after pancreaticoduodenectomy and are associated with substantial morbidity.3. Discuss how portal/mesenteric vein resection to achieve negative resection margins does not add to the morbidity of pancreaticoduodenectomy, does not worsen survival after resection, and is most often performed because of tumor location.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAdenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

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Postoperative Morbidity and Long-term Survival After Pancreaticoduodenectomy With Superior Mesenterico−Portal Vein Resection

Cited by 156 publications

References 33 publications

The Role of Vascular Resection in Pancreatic Cancer Treatment

The Role of Vascular Resection in Pancreatic Cancer Treatment

Portal Vein Resection During Pancreatectomy for Pancreatic Head Adenocarcinoma. Scope of Current Opinions and own Experiences

Extended Resection for Pancreatic Adenocarcinoma

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