Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection.

Abstract

We investigated retrospectively the operative outcomes of portal vein resection (PVR) for portal vein (PV) and/or superior mesenteric vein (SMV) involvement and clarified the validity of PVR. Between 1993 and 2006, 84 patients with invasive pancreatic head adenocarcinoma were resected by pancreatoduodenectomy with macroscopically curative resection. Forty-two patients underwent PVR by means of segmental resection with end-to-end anastomosis in 27 patients and autologous vein graft using an external iliac vein in 15 patients because of macroscopic venous involvement. Venous involvement was classified macroscopically as unilateral involvement (< or =180 degrees ; n = 27) or circumferential involvement (n = 15) and as short (the length of PVR < 3 cm; n = 15) or long (> or =3 cm; n = 27). Histopathologic parameters and survival were analyzed to confirm prognostic factors. Morbidity and mortality were not different based on PVR status. Median and 5-year survivals were 26 months and 32%, respectively, when there was no PVR (n = 42) and 12 months and 17% when there was PVR (n = 42); these values of median and 5-year survivals differed (P < .04 each) between the groups without and with PVR. Limiting the analysis to R0 (histologically curative) resections, median and 5-year survivals were 26 months and 34% when there was no PVR (n = 39) and 20 months and 23% when there was PVR (n = 32); these survivals were not significantly different between groups. In patients with PVR, there were no statistical differences in survival between those resected with or without a venous allograft and those with unilateral or circumferential involvement; however, short PVR showed better 5-year survival than long PVR (39% vs 4%; P = .017) despite similar positive rates of histologic venous invasion. PVR has comparable survival compared with no PVR only in patients undergoing an R0 resection. The short PV/SMV invasion that requires PVR <3 cm in length can result in respectable survival rates.