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.
Downloads
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 Jul. 18];36(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226201
Issue
Section
Original Articles
License
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
