Skip to main content

Advertisement

Log in

Does Portal-Superior Mesenteric Vein Invasion Still Indicate Irresectability for Pancreatic Carcinoma?

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pancreatic carcinoma frequently infiltrates the portal vein or the superior mesenteric vein; pancreatectomy combined with portal vein/superior mesenteric vein resection represents a potentially curative treatment in these cases but is still a controversial procedure.

Methods

After performing a computerized Medline search, 12 series published during the last 8 years were selected, enrolling 399 patients who underwent pancreatectomy combined with portal vein/superior mesenteric vein resection for pancreatic carcinoma. Data were examined for information about indications, operation, adjuvant therapies, histopathology of resected specimens, perioperative results, and survival. Also, previous literature regarding the issue was extensively reviewed.

Results

Operative mortality and postoperative complication rates ranged from 0 to 7.7% and 16.7% to 54%, respectively. Median survival varied from 13 to 22 months; 5-year survival rate ranged from 9% to 18%.

Conclusions

The current literature suggests that portal vein/superior mesenteric vein resection combined with pancreatectomy is a safe and feasible procedure that increases the number of patients who undergo curative resection and, therefore, provides important survival benefits to selected groups of patients. This procedure should always be considered in case of suspected tumor infiltration of portal/superior mesenteric vein to achieve clear resection margins, in the absence of other contraindications for resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  PubMed  Google Scholar 

  2. Katz MH, Hwang R, Fleming JB, Evans DB. Tumor-node-metastasis staging of pancreatic adenocarcinoma. CA Cancer J Clin. 2008;58:111–25.

    Article  PubMed  Google Scholar 

  3. Tseng JF, Tamm EP, Lee JE, Pisters PW, Evans DB. Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol. 2006;20:349–64.

    Article  PubMed  Google Scholar 

  4. Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, et al. Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg. 2001;25:1002–5.

    Article  PubMed  CAS  Google Scholar 

  5. Kawada M, Kondo S, Okushiba S, Morikawa T, Katoh H. Reevaluation of the indications for radical pancreatectomy to treat pancreatic carcinoma: is portal vein infiltration a contraindication? Surg Today. 2002;32:598–601.

    Article  PubMed  Google Scholar 

  6. Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg. 2003;186:149–53.

    Article  PubMed  Google Scholar 

  7. Capussotti L, Massucco P, Ribero D, Viganò L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.

    Article  PubMed  Google Scholar 

  8. Howard TJ, Villanustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg. 2003;7:1089–95.

    Article  PubMed  Google Scholar 

  9. Poon RT, Fan ST, Lo CM et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg. 2004;28:602–8.

    Article  PubMed  Google Scholar 

  10. Zhou GW, Wu WD, Xiao WD, Li HW, Peng CH. Pancreatectomy combined with superior mesenteric-portal vein resection: report of 32 cases. Hepatobiliary Pancreat Dis Int. 2005;4:130–4.

    PubMed  Google Scholar 

  11. Jain S, Sacchi M, Vrachnos P, Lygidakis NJ. Carcinoma of the pancreas with portal vein involvement: our experience with a modified technique of resection. Hepatogastroenterology. 2005;52:1596–600.

    PubMed  Google Scholar 

  12. Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg. 2006;10:1106–15.

    Article  PubMed  Google Scholar 

  13. Shimada K, Sano T, Sakamoto Y, Kosuge T. Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol. 2006;13:1569–78.

    Article  PubMed  Google Scholar 

  14. Al-Haddad M, Martin JK, Nguyen J et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg. 2007;11:1168–74.

    Article  PubMed  Google Scholar 

  15. Kurosaki I, Hatakeyama K, Minagawa M, Sato D. Portal vein resection in surgery for cancer of biliary tract and pancreas: special reference to the relationship between the surgical outcome and site of primary tumor. J Gastrointest Surg. 2008;12:907–18.

    Article  PubMed  Google Scholar 

  16. Tseng JF, Raut CP, Lee JE et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49.

    Article  PubMed  Google Scholar 

  17. Li B, Chen FZ, Ge XH, Cai MZ, Jiang JS, Li JP, et al. Pancreatoduodenectomy with vascular reconstruction in treating carcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int. 2004;3:612–5.

    PubMed  Google Scholar 

  18. Aramaki M, Matsumoto T, Etoh T et al. Clinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma. Hepatogastroenterology. 2003;50:263–6.

    PubMed  Google Scholar 

  19. Yoshimi F, Asato Y, Tanaka R, Nemoto K, Shioyama Y, Onaya H, et al. Reconstruction of the portal vein and the splenic vein in pancreaticoduodenectomy for pancreatic cancer. Hepatogastroenterology. 2003;50:856–60.

    PubMed  Google Scholar 

  20. Nakao A, Takeda S, Sakai M, Kaneko T, Inoue S, Sugimoto H, et al. Extended radical resection versus standard resection for pancreatic cancer: the rationale for extended radical resection. Pancreas. 2004;28:289–92.

    Article  PubMed  Google Scholar 

  21. Sasson AR, Hoffman JP, Ross EA, Kagan SA, Pingpank JF, Eisenberg BL. En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg. 2002;6:147–57.

    Article  PubMed  Google Scholar 

  22. Yekebas EF, Bogoevski D, Cataldegirmen G et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247:300–9.

    Article  PubMed  Google Scholar 

  23. Adham M, Mirza DF, Chapuis F et al. Results of vascular resections during pancreatectomy from two European centres: an analysis of survival and disease-free survival explicative factors. HBP (Oxford). 2006;8:465–73.

    CAS  Google Scholar 

  24. Van Geenen RC, ten Kate FJ, de Wit LT, van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001;129:158–63.

    Article  PubMed  Google Scholar 

  25. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001;182:120–9.

    Article  PubMed  CAS  Google Scholar 

  26. Smoot RL, Christein JD, Farnell MB. Durability of portal venous reconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg. 2006;10:1371–5.

    Article  PubMed  Google Scholar 

  27. Carrère N, Sauvanet A, Goere D et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–35.

    Article  PubMed  Google Scholar 

  28. Fukuda S, Oussoultzoglou E, Bachellier P, Rosso E, Nakano H, Audet M, et al. Significance of the depth of portal vein wall invasion after curative resection for pancreatic adenocarcinoma. Arch Surg. 2007;142:172–9.

    Article  PubMed  Google Scholar 

  29. Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg. 2006;30:976–82.

    Article  PubMed  Google Scholar 

  30. Lygidakis NJ, Singh G, Bardaxoglou E, et al. Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study. Hepatogastroenterology. 2004;51:427–33.

    CAS  Google Scholar 

  31. Nakao A, Kaneko T, Takeda S, Inoue S, Harada A, Nomoto S, et al. The role of extended radical operation for pancreatic cancer. Hepatogastroenterology. 2001;48:949–52.

    PubMed  CAS  Google Scholar 

  32. Ni QX, Zhang QH, Fu DL, Cao GH, Yao QY, Jin C, et al. Curative resection of pancreatic head carcinoma in recent 30 years: report of 377 cases. Hepatobiliary Pancreat Dis Int. 2002;1:126–8.

    PubMed  Google Scholar 

  33. Siriwardana HP, Siriwardena AK. Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006;93:662–73.

    Article  PubMed  CAS  Google Scholar 

  34. Moore GE, Sako Y, Thomas LB. Radical pancreaticoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery. 1951;30:550–3.

    PubMed  CAS  Google Scholar 

  35. Asada S, Itaya H, Nakamura K et al. Radical pancreatectomy and portal vein resection. Report of two successful cases with transplantation of portal vein. Arch Surg. 1963;87:609–13.

    PubMed  CAS  Google Scholar 

  36. Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973;73:307–20.

    PubMed  CAS  Google Scholar 

  37. Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 1989;1124:127–32.

    Google Scholar 

  38. Yeo CJ, Cameron JL, Lillemoe KD et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–68.

    Article  PubMed  Google Scholar 

  39. Fuhrman GM, Leach SD, Staley CA et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg. 1996;223:154–62.

    Article  PubMed  CAS  Google Scholar 

  40. Leach SD, Lee JE, Charnsangavej C et al. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg. 1998;85:611–7.

    Article  PubMed  CAS  Google Scholar 

  41. Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma A contraindication for resection?. Ann Surg. 1996;224:342–9.

    Article  PubMed  CAS  Google Scholar 

  42. Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg. 1996;171:170–5.

    Article  PubMed  CAS  Google Scholar 

  43. Wray CJ, Ahmad SA, Matthews JB, Lowy AM. Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterology. 2005;128:1626–41.

    Article  PubMed  Google Scholar 

  44. Sohn TA, Yeo CJ, Cameron JL et al. Resected adenocarcinoma of the pancreas - 616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4;567–79.

    Article  PubMed  CAS  Google Scholar 

  45. Nagakawa T, Sanada H, Inagaki M et al. Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection. J Hepatobiliary Pancreat Surg. 2004;11:402–8.

    Article  PubMed  Google Scholar 

  46. Takai S, Satoi S, Toyokawa H et al. Clinicopathological evaluation after resection for ductal adenocarcinoma of the pancreas: a retrospective, single-institution experience. Pancreas. 2003;26:243–9.

    Article  PubMed  CAS  Google Scholar 

  47. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adencarcinoma. Br J Surg. 2004;94:586–94.

    Article  Google Scholar 

  48. Kuhlmann KF, de Castro SM, Wesseling JG et al. Surgical treatment of pancreatic adenocarcinoma: actual survival and prognostic factors in 343 patients. Eur J Cancer. 2004;40:549–58.

    Article  PubMed  CAS  Google Scholar 

  49. Benassai G, Mastrorilli M, Quarto G, Cappiello A, Giani U, Forestieri P, et al. Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas. J Surg Oncol. 2000;73:212–8.

    Article  PubMed  CAS  Google Scholar 

  50. Espat NJ. “Aggressive” operations for pancreatic cancer: technical and biologic challenges. World J Surg. 2006;30:983–4.

    Article  Google Scholar 

  51. Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol. 2004;59:26–38.

    Article  PubMed  CAS  Google Scholar 

  52. Furukawa H, Kosuge T, Mukai K et al. Helical computed tomography in the diagnosis of portal vein invasion by pancreatic head carcinoma. Usefulness for selecting surgical procedures and predicting the outcome. Arch Surg. 1998;133:61–5.

    Article  PubMed  CAS  Google Scholar 

  53. Brügel M, Link TM, Rummeny EJ, Lange P, Theisen J, Dobritz M. Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions. Eur Radiol. 2004;14:1188–95.

    Article  PubMed  Google Scholar 

  54. Soriano A, Castells A, Ayuso C et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol. 2004;99:492–501.

    Article  PubMed  Google Scholar 

  55. Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol. 1997;168:1439–43.

    CAS  Google Scholar 

  56. Kulig J, Popiela T, Zajac A, Kłek S, Kołodziejczyk P. The value of imaging techniques in the staging of pancreatic cancer. Surg Endosc. 2005;19:361–5.

    Article  PubMed  CAS  Google Scholar 

  57. Megibow AJ, Zhou XH, Rotterdam H et al. Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability - Report of the Radiology Diagnostic Oncology Group. Radiology. 1995;195:327–32.

    PubMed  CAS  Google Scholar 

  58. Fritscher-Ravens A, Knoefel WT, Krause C, Swain CP, Brandt L, Patel K. Three-dimensional linear endoscopic ultrasound-feasibility of a novel technique applied for detection of vessel involvement of pancreatic masses. Am J Gastroenterol. 2005;100:1296–302.

    Article  PubMed  Google Scholar 

  59. Varadhachary GR, Tamm EP, Abbruzzese JL et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.

    Article  PubMed  Google Scholar 

  60. Machado MC, Figueira ER, Machado MA, Jukemura J, Cunha JE, Perini MV, Bacchella T. Portal vein resection: a modified technique for reconstruction after pancreaticoduodenectomy. J Surg Oncol. 2004;88:52–4.

    Article  PubMed  Google Scholar 

  61. Koniaris LG, Schoeniger LO, Kovach S, Sitzmann JV. The quick, no-twist, no-kink portal confluence reconstruction. J Am Coll Surg. 2003;196:490–4.

    Article  PubMed  Google Scholar 

  62. Fujisaki S, Tomita R, Fukuzawa M. Utility of mobilization of the right colon and the root of the mesentery for avoiding vein grafting during reconstruction of the portal vein. J Am Coll Surg. 2001;193:576–78.

    Article  PubMed  CAS  Google Scholar 

  63. Misuta K, Shimada H, Miura Y et al. The role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy. J Gastrointest Surg. 2005;9:245–53.

    Article  PubMed  Google Scholar 

  64. Chiu KM, Chu SH, Chen JS, Li SJ, Chan CY, Chen KS. Spiral saphenous vein graft for portal vein reconstruction in pancreatic cancer surgery. Vasc Endovasc Surg. 2007;41:149–52.

    Article  Google Scholar 

  65. Ohwada S, Hamada K, Kawate S et al. Left renal vein graft for vascular reconstruction in abdominal malignancy. World J Surg. 2007;31:1215–20.

    Article  PubMed  Google Scholar 

  66. Smoot RL, Christein JD, Farnell MB. An innovative option for venous reconstruction after pancreaticoduodenectomy: the left renal vein. J Gastrointest Surg. 2007;11:425–31.

    Article  PubMed  Google Scholar 

  67. Fleming JB, Barnett CC, Clagett P. Superficial femoral vein as a conduit for portal vein reconstruction during pancreaticoduodenectomy. Arch Surg. 2005;140:698–701.

    Article  PubMed  Google Scholar 

  68. Tashiro S, Uchino R, Hiraoka T et al. Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Surgery. 1991;109:481–7.

    PubMed  CAS  Google Scholar 

  69. Tuech JJ, Pessaux P, Arnaud JP. Portal vein resection in pancreatic head carcinoma. Part 1: technical considerations. Hepatogastroenterology. 2001;48:884–7.

    PubMed  CAS  Google Scholar 

  70. Bold RJ, Charnsangavej C, Cleary KR et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg. 1999;3:233–43.

    Article  PubMed  CAS  Google Scholar 

  71. Yeo CJ, Cameron JL, Lillemoe KD et al. Pancreaticoduodenectomy for cancer of the head of the pancreas 201 patients. Ann Surg. 1995;221:721–31.

    Article  PubMed  CAS  Google Scholar 

  72. Winter JM, Cameron JL, Campbell KA et al. 1423 Pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–211.

    Article  PubMed  Google Scholar 

  73. Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.

    Article  PubMed  Google Scholar 

  74. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–5.

    Article  PubMed  Google Scholar 

  75. Yeo CJ, Cameron JL, Sohn TA et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.

    Article  PubMed  CAS  Google Scholar 

  76. Büchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’graggen K. Changes in morbidity after pancreatic resection. Toward the end of completion pancreatectomy. Arch Surg. 2003;138:1310–4.

    Article  PubMed  Google Scholar 

  77. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg. 2003;27:324–9.

    Article  PubMed  Google Scholar 

  78. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume: toward the end of completion pancreatectomy. Ann Surg. 2000;232:786–95.

    Article  PubMed  CAS  Google Scholar 

  79. McPhee JT, Hill JS, Whalen GF et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246:246–53.

    Article  PubMed  Google Scholar 

  80. Adam U, Makowiec F, Riediger H et al. Risk factors for complications after pancreatic head resection. Am J Surg. 2004;187:201–8.

    Article  PubMed  Google Scholar 

  81. Leon LR Jr, Hughes JD, Psalms SB, Guerra R, Biswas A, Prasad A, et al. Portomesenteric reconstruction during Whipple procedures: review and report of a case. Vasc Endovasc Surg. 2008;41:537–46.

    Article  Google Scholar 

  82. National Cancer Institute, Pancreatic Cancer Treatment. http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/HealthProfessional. Accessed 7 Sept 2008.

  83. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology. Pancreatic adenocarcinoma. http://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf. Accessed 7 Sept 2008.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Ramacciato MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ramacciato, G., Mercantini, P., Petrucciani, N. et al. Does Portal-Superior Mesenteric Vein Invasion Still Indicate Irresectability for Pancreatic Carcinoma?. Ann Surg Oncol 16, 817–825 (2009). https://doi.org/10.1245/s10434-008-0281-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0281-8

Keywords

Navigation