BACKGROUND/AIMS: A positive surgical margin is a poor prognosis factor. Resection of the invaded portal vein (PV) may be necessary to achieve a negative surgical margin during pancreaticoduodenectomy (PD). This study clarifies the intraoperative and long-term survival of patients who received PD with PV resection compared to without. METHODOLOGY: Between July 1992 and March 2012, a retrospective analysis of 119 patients undergoing PD with or without PV resection for pancreatic head cancer was performed. Main outcome measures were perioperative mortality and survival rate of PD with and without PV resection. RESULTS: Perioperative mortality was not different between PD (1 of 51 cases: 2.0%) and PD with PV resection (3 of 68 cases: 4.4%) (p = 0.462). Patients without resection had a significantly better prognosis than patients with PV resection (p = 0.0052). Patients on whom >2.1 cm of the PV was resected (n = 34) had a worse cumulative survival rates than patients with a resection of <2.1 cm (n = 19) (p = 0.0380). Patients with no invasion of PV wall (n = 18) had a significantly higher survival rate than positive PV wall invasion (n = 49) (p =0.039). CONCLUSIONS: Patients with PV resection had a significantly worse prognosis than patients without PV resection. Some patients survived more than 5 years post-operation after PD with PV resection. PV resection contributes to attaining complete tumor resection.
BACKGROUND/AIMS: A positive surgical margin is a poor prognosis factor. Resection of the invaded portal vein (PV) may be necessary to achieve a negative surgical margin during pancreaticoduodenectomy (PD). This study clarifies the intraoperative and long-term survival of patients who received PD with PV resection compared to without. METHODOLOGY: Between July 1992 and March 2012, a retrospective analysis of 119 patients undergoing PD with or without PV resection for pancreatic head cancer was performed. Main outcome measures were perioperative mortality and survival rate of PD with and without PV resection. RESULTS: Perioperative mortality was not different between PD (1 of 51 cases: 2.0%) and PD with PV resection (3 of 68 cases: 4.4%) (p = 0.462). Patients without resection had a significantly better prognosis than patients with PV resection (p = 0.0052). Patients on whom >2.1 cm of the PV was resected (n = 34) had a worse cumulative survival rates than patients with a resection of <2.1 cm (n = 19) (p = 0.0380). Patients with no invasion of PV wall (n = 18) had a significantly higher survival rate than positive PV wall invasion (n = 49) (p =0.039). CONCLUSIONS:Patients with PV resection had a significantly worse prognosis than patients without PV resection. Some patients survived more than 5 years post-operation after PD with PV resection. PV resection contributes to attaining complete tumor resection.
Authors: Enio Campos Amico; José Roberto Alves; Samir Assi João; Ricardo Wagner da Costa Moreira; José Linhares da Silva Neto; Joafran Alexandre Costa de Medeiros Journal: Arq Bras Cir Dig Date: 2014 Nov-Dec