Postoperative Morbidity and Long-term Survival After Pancreaticoduodenectomy With Superior Mesenterico−Portal Vein Resection

Hilar cholangiocarcinoma remains a difficult challenge for the surgeon. Achieving negative surgical margins when resecting this relatively uncommon tumor is technically demanding as a result of the close proximity of the bile duct bifurcation to the vascular inflow of the liver. A recent advance in surgical treatment is the addition of portal vein resection to the procedure. Resection of the portal vein increases the number of patients offered a potentially curative approach but is technically more difficult and may increase the risk of the procedure. This study reviews the results of portal vein resection for hilar cholangiocarcinoma. Between 1998 and 2005, 60 patients underwent potentially curative resections of hilar cholangiocarcinoma. Mean patient age was 64 ± 12 years (range, 24–85 years). Liver resections performed along with biliary resection included 49 trisegmentectomies (37 right, 12 left) and 10 lobectomies (8 left, 2 right). One patient had only the bile duct resected. Four patients also had simultaneous pancreaticoduodenectomy performed. Twenty-six patients required portal vein resection and reconstruction to achieve negative margins, 3 of which also required reconstruction of the hepatic artery. Operative mortality was 8 per cent with an overall complication rate of 40 per cent. Patients who underwent portal vein resection had an operative mortality of 4 per cent, which was not different from the 12 per cent mortality in patients who did not undergo portal vein resection (P = 0.39). There was no difference in actuarial patient survival between patients who underwent portal vein resection and those who did not (5-year survival 39 per cent vs. 41 per cent, P = not significant). Negative margins were achieved in 80 per cent of cases and were associated with improved survival (P < 0.01). Five-year actuarial survival in patients undergoing resection with negative margins was 45 per cent. There was no difference in margin status or long-term survival between those patients who underwent portal vein resection and those who did not. Only negative margin status was associated with improved survival by multivariate analysis. Portal vein resection for hilar cholangiocarcinoma is safe and allows a chance for long-term survival in otherwise unresectable patients.

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Mesenteric-Portal Vein Resection during Pancreatectomy for Pancreatic Cancer

Gastroenterology Research and Practice ◽

10.1155/2015/659730 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 14

Author(s):

Valentina Beltrame ◽

Mario Gruppo ◽

Sergio Pedrazzoli ◽

Stefano Merigliano ◽

Davide Pastorelli ◽

...

Keyword(s):

Pancreatic Cancer ◽

Portal Vein ◽

Pancreatic Resection ◽

Vascular Invasion ◽

Morbidity And Mortality ◽

Portal Vein Resection ◽

Venous Resection ◽

Term Survival ◽

Vein Resection

The aim of the present study was to determine the outcome of patients undergoing pancreatic resection with (VR+) or without (VR−) mesenteric-portal vein resection for pancreatic carcinoma. Between January 1998 and December 2012, 241 patients with pancreatic cancer underwent pancreatic resection: in 64 patients, surgery included venous resection for macroscopic invasion of mesenteric-portal vein axis. Morbidity and mortality did not differ between the two groups (VR+: 29% and 3%; VR−: 30% and 4.0%, resp.). Radical resection was achieved in 55/64 (78%) in the VR+ group and in 126/177 (71%) in the VR− group. Vascular invasion was histologically proven in 44 (69%) of the VR+ group. Survival curves were not statistically different between the two groups. Mean and median survival time were 26 and 15 months, respectively, in VR− versus 20 and 14 months, respectively, in VR+ groupp=0.52. In the VR+ group, only histologically proven vascular invasion significantly impacted survivalp=0.02, while, in the VR− group, R0 resectionp=0.001and tumor’s gradingp=0.01significantly influenced long-term survival. Vascular resection during pancreatectomy can be performed safely, with acceptable morbidity and mortality. Long-term survival was the same, with or without venous resection. Survival was worse for patients with histologically confirmed vascular infiltration.

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Pancreatoduodenectomy with mesentericoportal vein resection: Postoperative morbidity and long-term survival

Gastroenterology ◽

10.1016/s0016-5085(03)84144-6 ◽

2003 ◽

Vol 124 (4) ◽

pp. A821-A822

Author(s):

Frank Makowiec ◽

Hartwig Riediger ◽

Ulrich Adam ◽

Ulrich T. Hopt

Keyword(s):

Postoperative Morbidity ◽

Term Survival ◽

Long Term Survival ◽

Vein Resection

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Impact of Radical Pancreaticoduodenectomy with Portal Vein Resection and Extensive Surrounding Soft Tissues on the Long-term Outcomes for Pancreatic Head Cancer

HPB ◽

10.1016/j.hpb.2020.11.152 ◽

2021 ◽

Vol 23 ◽

pp. S63

Author(s):

A. Saiura ◽

H. Ito ◽

A. Oba ◽

Y. Inoue ◽

Y. Mise ◽

...

Keyword(s):

Portal Vein ◽

Soft Tissues ◽

Pancreatic Head ◽

Portal Vein Resection ◽

Long Term Outcomes ◽

Head Cancer ◽

Pancreatic Head Cancer ◽

Vein Resection

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Postoperative Morbidity in Curative Resection of Gastroesophageal Carcinoma Does Not Impact Long-term Survival

The American Surgeon ◽

10.1177/000313481508101222 ◽

2015 ◽

Vol 81 (12) ◽

pp. 1228-1231

Author(s):

Jennifer E. Samples ◽

Anna C. Snavely ◽

Michael O. Meyers

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Neoadjuvant Therapy ◽

Postoperative Morbidity ◽

Gastroesophageal Junction ◽

Morbidity And Mortality ◽

Term Survival ◽

Long Term Survival ◽

Nodal Dissection

Significant morbidity and mortality have historically been reported for surgical resection of gastric and gastroesophageal junction tumors. We evaluated our experience to determine morbidity and mortality and evaluated demographic and pathologic risk factors associated with postoperative outcome and long-term survival. A retrospective, Institutional Review Board-approved, single-institution database identified 102 patients who underwent resection with curative intent for gastroesophageal junction or gastric carcinoma from 2004 to 2012. The method of Kaplan and Meier was used to describe overall survival and estimate median survival. Of 102 patients, 74 were male and 28 were female. Of these, 24 patients were > 70 years of age at surgery (median = 62.9). Forty esophagectomies, 25 total gastrectomies, and 37 subtotal gastrectomies were performed. Two patients died (one esophagectomy and one gastrectomy). Forty-one developed a complication: 17 minor and 35 major, including six anastomotic leaks. Patients with low preoperative albumin ( P = 0.01) and increased age ( P = 0.05) were associated with having a postoperative complication; extent of nodal dissection ( P = 0.48), jejunostomy (0.24), performance status ( P = 0.77), type of surgery ( P = 0.74), and neoadjuvant therapy ( P = 0.24) were not associated. More extensive nodal dissection was associated with a decreased risk of death ( P = 0.007). Having any complication ( P = 0.20), an anastomotic leak ( P = 0.17), worse grade of complication ( P = 0.15), presence of feeding jejunostomy tube ( P = 0.17), and neoadjuvant therapy ( P = 0.30) were not associated with changes in overall survival. Thorough lymph node dissection improves survival without increasing postoperative morbidity. The data advocate for increased lymph node yield and close attention to nutritional support in gastroesophageal carcinoma patients.

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