Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy

• Published in: Surgery Vol. 129; no. 2; pp. 158 - 163
• Main Authors: van Geenen, Rutger C.I., ten Kate, Febo J.W., de Wit, Laurens Th, van Gulik, Thomas M., Obertop, Huug, Gouma, Dirk J.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-02-2001; Elsevier
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Bile Ducts; Biological and medical sciences; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Mesenteric Veins - pathology; Mesenteric Veins - surgery; Middle Aged; Pancreatic Ducts; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Portal Vein - surgery; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Human; Statistical analysis; Resection; Duodenum; Mortality; Intraoperative; Superior mesenteric vein; Survival; Morbidity; Association; Surgery; Strategy; Portal vein; Pancreas; Pancreatoduodenectomy
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1067/msy.2001.110221

Background. Resection of the portal/superior mesenteric vein (PV/SMV) during pancreatoduodenectomy (PD) is disputed. Although morbidity and mortality are acceptable, survival is limited after PV/SMV resection. In this study, we evaluate the effect of PV/SMV resection. Methods. Between 1992 and 1998, there were 215 consecutive patients who underwent PD for malignant disease. Thirty-four patients underwent a PV/SMV resection. Resection was only performed when minimal venous ingrowth was found perioperatively. Surgical techniques, perioperative parameters, and survival were analyzed. Results. The percentage of PV/SMV resections was 16%. Extensive (segment) resections were performed in 6 patients. The median blood loss was 1.8 L and resection margins were microscopically tumor free in 41% of the patients. The median hospital stay was 15 days, and mortality was 0%. Median survival after PV/SMV resection for pancreatic adenocarcinoma was 14 months. Conclusions. Limited PV/SMV resection for perioperatively encountered minimal venous ingrowth during PD can be performed safely without increased morbidity and mortality but also results in a high frequency of tumor-positive resection margins. (Surgery 2001;129:158-63.)