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Vein resection in patients with adenocarcinoma of the head of 
pancreas adherent to the portomesenteric venous axis is 
beneficial despite a high rate of R1 resection

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):261-8
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Ramkiran Cherukuru1, Sanjay Govil1, Mukul Vij1, Mohamed Rela1,2

1Gleneagles Global Hospital and Health City, Chennai, India, 
2Institute of Liver Studies, King’s College Hospital, London, UK
Received November 28, 2017; Revised April 24, 2018; Accepted April 26, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: En-bloc vein resection (VR) for pancreatic ductal adenocarcinoma (PDAC) of the head of pancreas adherent to the portomesenteric axis benefits patients when the vein wall is not infiltrated by tumour and an R0 resection is achieved, albeit at the expense of greater morbidity and mortality. 
Methods: A retrospective review of pancreaticoduodenectomy for PDAC over 6 years was conducted. Patients were divided into a standard resection group (Group SR) and simultaneous vein resection group (Group VR) and compared for outcome. 
Results: The study group consisted of 41 patients (Group SR 15, Group VR 26). VR was performed by end-to-end reconstruction in 12 patients and with interposition grafts in 13 cases (autologous vein in 10, PTFE in 3). R1 resections occurred in 49% patients, with the superior mesenteric artery margin most commonly involved. Patients with Ishikawa grade III and IV vein involvement were more likely to carry a positive SMA margin (p=0.04). Involvement of the splenoportal junction was associated with a significantly greater risk of pancreatic transection margin involvement. No difference in morbidity was seen between the groups. Median survival in the entire group of patients was 17 months and did not vary significantly between the groups. The only significant predictor of survival was lymph node status. Conclusions: Venous involvement by proximal PDAC is indicative of tumor location rather than tumor biology. VR improves outcomes in patients with tumor adhesion to the portomesenteric venous axis despite a high incidence of R1 resections and greater operative mortality.
Keywords : Pancreatic cancer; Vein involvement; Borderline resectable; Vein resection; Survival

 

August 2018, 22 (3)