Who Benefits from Portal Vein Resection during Pancreaticoduodenectomy for Pancreatic Cancer?

Launois, B; Stasik, Christian; Bardaxoglou, E.; Meunier, Brigitte; Campion, Jean‐Pierre; Greco, Luigi; Sutherland, Francis

doi:10.1007/s002689900601

Cited by 80 publications

(62 citation statements)

References 24 publications

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“…The presence of portal thrombosis and collateral circulation remain a contraindication to resection. Venous resection increases the resectability rate [12] but it is indicated only in cases where it can provide a complete tumor resection [13].…”

Section: Discussionmentioning

confidence: 99%

Portal vein resection: A modified technique for reconstruction after pancreaticoduodenectomy

Machado

Figueira

Jukemura

et al. 2004

Journal of Surgical Oncology

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Pancreaticoduodenectomy is the only curative treatment for pancreatic head tumors. The possibility to achieve a potentially curative surgical treatment is limited to patients in which a complete tumor resection can be performed with free surgical margins. In a small number of patients with localized pancreatic cancer, negative margins are only accomplished with portal vein resection. Pancreaticoduodenectomy is often avoided in these patients due to the mistaken concept that venous resection may be followed by higher mortality and carries poorer survival. Actually, these patients present the same survival rate as patients similarly staged in whom portal vein resection was not performed. Therefore, venous resection is worthwhile. The authors describe an alternative technique for venous reconstruction after resection of a long segment of portal or superior mesenteric vein. The use of a venous graft as proposed in this study is feasible, easy to perform, and may simplify the venous reconstruction even in extensive mesentericoportal venous resection.

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Section: Discussionmentioning

confidence: 99%

Portal vein resection: A modified technique for reconstruction after pancreaticoduodenectomy

Machado

Figueira

Jukemura

et al. 2004

Journal of Surgical Oncology

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“…2007;142:172-179 E XTENDED PANCREATIC RESECtion for portal vein (PV) invasion due to locally advanced pancreatic cancer was initially associated with high mortality and morbidity. [1][2][3] However, during the past decade, the surgical procedure and perioperative care have improved and allowed an extended operation combined with a PV resection to be performed safely. [4][5][6][7][8][9][10][11][12] According to these reports, perioperative mortality decreased to rates between 0% and 5.4%, and morbidity also decreased to rates between 12% and 41%.…”

Section: Discussionmentioning

confidence: 99%

Significance of the Depth of Portal Vein Wall Invasion After Curative Resection for Pancreatic Adenocarcinoma

Fukuda

Oussoultzoglou²,

Bachellier³

et al. 2007

Arch Surg

110

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“…Es hat sich in den letzten Jahren gezeigt, dass die Mortalität nach partieller Pfortaderresektion nicht signifikant höher liegt als bei Pankreatikoduodenektomie ohne Gefäßresektion. Wenngleich sich auch aus den vorliegenden Studien keine Evidenz ableiten lässt, dass eine partielle Pfortaderresektion im Rahmen einer Pankreaskarzinomresektion die Prognose des Patienten verbessert, so kann doch durch einen solchen Eingriff eine R0-Situation (also potenziell eine Kuration) erreicht werden [2,12,17,21,27,32,36,41,42]. Zurzeit gilt als internationaler Standard, dass eine isolierte Infiltration der Pfortader zumindest keine Kontraindikation für eine Resektion darstellt.…”

Section: Pankreaschirurgieder Chirurg Als Wesentlicher Prognostischerunclassified

Chirurgische Standardtherapie beim Pankreaskarzinom

Frieß

Kleeff

Fischer

et al. 2003

Chirurg

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Approximately 150,000 people worldwide and 40,000 people in Europe die each year of pancreatic cancer,making it one of the five leading causes of cancer-related death and one of the most aggressive human tumors. Resection is still the only option that offers a chance of cure for pancreatic cancer patients. Recent studies have highlighted the correlation between the number of pancreatic resections per year and postoperative mortality. Thus, large centers of pancreatic surgery have mortality rates below 5%, whereas centers with lower caseloads have mortality rates exceeding 10%. Standards have been established for the surgical treatment of pancreatic cancer;however, these are often not based on evidence derived from randomized, controlled studies. Resection for pancreatic cancer is carried out if there are no metastases present and if the tumor is locally resectable; i.e., if there is no complex vessel invasion. However, an isolated infiltration of the portal vein is not considered a contraindication for surgery. At present, there are no evidenced-based data available on palliative (R2) resections,which might be a therapeutic option in centers with low morbidity/mortality. Three randomized controlled trials clearly show that the pylorus-preserving Whipple is equal to the classical Whipple in terms of oncological effectiveness, morbidity, and quality of life. Therefore, the pylorus-preserving Whipple is increasingly considered the standard operation for tumors of the pancreatic head. Based on randomized trials, extended lymph node dissection cannot generally be recommended for pancreatic cancer. Further prospective, randomized, multicenter trials have to be carried out in the upcoming years to find new approaches in the therapy of pancreatic cancer and to establish evidence-based treatment strategies for this disease.

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Who Benefits from Portal Vein Resection during Pancreaticoduodenectomy for Pancreatic Cancer?

Cited by 80 publications

References 24 publications

Portal vein resection: A modified technique for reconstruction after pancreaticoduodenectomy

Portal vein resection: A modified technique for reconstruction after pancreaticoduodenectomy

Significance of the Depth of Portal Vein Wall Invasion After Curative Resection for Pancreatic Adenocarcinoma

Chirurgische Standardtherapie beim Pankreaskarzinom

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