Safety and Feasibility of Pancreaticoduodenectomy with Venous Reconstruction: Maharaj Nakorn Chiang Mai Hospital’s Experience
Keywords:
Pancreaticoduodenectomy, whipple operation, venous reconstruction, pancreatic cancerAbstract
Background: Pancreaticoduodenectomy (PD) with venous reconstruction is becoming a more common practicein locally advanced pancreatic adenocarcinoma in which tumors adhere or invade portal vein (PV) or superior
mesenteric vein (SMV). Our objective was to compare short-term outcomes of PD with venous reconstruction (VR
group) to a standard PD (non-VR group) in our center.
Materials and Methods: This retrospective study recruited 43 patients who underwent PD by a single surgeon
from July 2010- June 2013. Seventeen patients underwent PD with VR and 26 were in non-VR group. All charts were
reviewed, including demographic data, operative details, and complications. Disease-free survival (DFS) and overall
survival were evaluated.
Results: Of 43 patients, there were significant differences in operative time and amount of blood loss between
both groups. However, length of stay of both groups had no difference. Pathological PV/SMV invasion in VR group
was 41.7%. Mortality rate was not different in both groups. Overall survival and DFS in the VR group were 9 months
and 6.5 months respectively.
Conclusion: PD with venous reconstruction is safe and effective in selected cases. Short-term outcomes are
similar to those in non-vascular reconstruction group. Mortality rate in both groups are high. PD with VR should remain
the standard of care for locally advanced peri-ampullary cancer.
References
1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer
statistics, 2009. CACancer J Clin 2009;59(4):225-49.
2. Hariharan D, Saied A, Kocher H.M. Analysis of mortality rates
for pancreatic Cancer across the world. HBP 2008;10(1):58-62.
3. Fortner JG. Regional resection of cancer of the pancreas: a
new surgical approach. Surgery. 1973;73:307-20.
4. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is
pancreaticoduodenectomy with mesentericoportal venous
resection safe and worthwhile? Am J Surg. 2001;182:120-29.
5. Carrére N, Sauvanet A, Goere D, et al. Pancreaticoduodenectomy
with mesentericoportal vein resection for
adenocarcinoma of the pancreatic head. World J Surg
2006;30:1526-35.
6. Leach SD, Lee JE, Charnsangavej C, et al. Survival following
pancreaticoduodenectomy with resection of the superior
mesenteric-portal vein confluence for adenocarcinoma of
the pancreatic head. Br J Surg 1998;85:611-17.
7. Nakao A, Takeda S, Inoue S, et al. Indications and techniques
of extended resection for pancreatic cancer. World J Surg
2006;30:976-82.
8. 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;10:1106-15.
9. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic
fistula: an international study group (ISGPF) definition. Surgery
2005;138(1):8-13.
10. Asada S, Itaya H, Nakamura K, Isohashi T, Masuoka S. Radical
pancreatectomy and portal vein resection: report of two
successful cases with transplantation of portal vein. Arch Surg
1963;87:609-13.
11. Sigel B, Bassett JG, Cooper D, Dunn MR. Resection of the
superior mesenteric vein and replacement with a venous
autograft during pancreaticoduodenectomy: case report.
Ann Surg 1985;162:941-45.
12. Longmire WP Jr. The technique of pancreaticoduodenal
resection. Surgery 1966;59:344-52.
13. Amano H, Miura F, Takada T, Sano K. Portal vein resection inpancreaticoduodenectomy (with video). J Hepatobiliary
Pancreat Sci. 2012;19:109-15.
14. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy
with or without distal gastrectomy and
extended retroperitoneal lymphadenectomy for periampullary
adenocarcinoma, part 2: randomized controlled trial
evaluating survival, morbidity, and mortality. Ann Surg.
2002;236:355-66.
15. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy
with vascular resection: margin status and survival duration. J
Gastrointest Surg 2004;8:935-49.
16. Al-Haddad M, Martin JK, Nguyen J, et al. J Gastrointest Surg
2007;11:1168-74.
17. Siriwardana HP, Siriwardena AK. Systematic Review of
Outcome of Synchronous Portal- superior Mesenteric Vein
Resection During Pancreatectomy for Cancer. Br J Surg
2006;93: 662-73.
18. McCullough DL, Gittes RF. Ligation of the renal vein in the
solitary kidney: Effects on renal function. J Urol 1975;113 (3):295-
98.
19. Miyazaki M, Itoh H, Kaiho T, et al. Portal vein reconstruction at
the hepatic hilus using a left renal vein graft. J Am Coll Surg
1995;180(4):497-98.
statistics, 2009. CACancer J Clin 2009;59(4):225-49.
2. Hariharan D, Saied A, Kocher H.M. Analysis of mortality rates
for pancreatic Cancer across the world. HBP 2008;10(1):58-62.
3. Fortner JG. Regional resection of cancer of the pancreas: a
new surgical approach. Surgery. 1973;73:307-20.
4. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is
pancreaticoduodenectomy with mesentericoportal venous
resection safe and worthwhile? Am J Surg. 2001;182:120-29.
5. Carrére N, Sauvanet A, Goere D, et al. Pancreaticoduodenectomy
with mesentericoportal vein resection for
adenocarcinoma of the pancreatic head. World J Surg
2006;30:1526-35.
6. Leach SD, Lee JE, Charnsangavej C, et al. Survival following
pancreaticoduodenectomy with resection of the superior
mesenteric-portal vein confluence for adenocarcinoma of
the pancreatic head. Br J Surg 1998;85:611-17.
7. Nakao A, Takeda S, Inoue S, et al. Indications and techniques
of extended resection for pancreatic cancer. World J Surg
2006;30:976-82.
8. 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;10:1106-15.
9. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic
fistula: an international study group (ISGPF) definition. Surgery
2005;138(1):8-13.
10. Asada S, Itaya H, Nakamura K, Isohashi T, Masuoka S. Radical
pancreatectomy and portal vein resection: report of two
successful cases with transplantation of portal vein. Arch Surg
1963;87:609-13.
11. Sigel B, Bassett JG, Cooper D, Dunn MR. Resection of the
superior mesenteric vein and replacement with a venous
autograft during pancreaticoduodenectomy: case report.
Ann Surg 1985;162:941-45.
12. Longmire WP Jr. The technique of pancreaticoduodenal
resection. Surgery 1966;59:344-52.
13. Amano H, Miura F, Takada T, Sano K. Portal vein resection inpancreaticoduodenectomy (with video). J Hepatobiliary
Pancreat Sci. 2012;19:109-15.
14. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy
with or without distal gastrectomy and
extended retroperitoneal lymphadenectomy for periampullary
adenocarcinoma, part 2: randomized controlled trial
evaluating survival, morbidity, and mortality. Ann Surg.
2002;236:355-66.
15. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy
with vascular resection: margin status and survival duration. J
Gastrointest Surg 2004;8:935-49.
16. Al-Haddad M, Martin JK, Nguyen J, et al. J Gastrointest Surg
2007;11:1168-74.
17. Siriwardana HP, Siriwardena AK. Systematic Review of
Outcome of Synchronous Portal- superior Mesenteric Vein
Resection During Pancreatectomy for Cancer. Br J Surg
2006;93: 662-73.
18. McCullough DL, Gittes RF. Ligation of the renal vein in the
solitary kidney: Effects on renal function. J Urol 1975;113 (3):295-
98.
19. Miyazaki M, Itoh H, Kaiho T, et al. Portal vein reconstruction at
the hepatic hilus using a left renal vein graft. J Am Coll Surg
1995;180(4):497-98.
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Published
2015-06-30
How to Cite
1.
Junrungsee S, Ko-iam W, Chotirosniramit A, Sandhu T. Safety and Feasibility of Pancreaticoduodenectomy with Venous Reconstruction: Maharaj Nakorn Chiang Mai Hospital’s Experience. Thai J Surg [Internet]. 2015 Jun. 30 [cited 2024 Nov. 6];36(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226201
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