[Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments].
OBJECTIVE
Vessel infiltration of the portal vein is often considered as contraindication for pancreas resection for carcinoma. In this retrospective analysis we investigated if an extended Whipple's procedure including vessel resection submits the patient to a significantly higher risk.


METHODS
From August 1985 until February 1994 179 Whipple's procedures were carried out, in 74 cases for carcinoma of the pancreatic head. In this group 26 patients were classified as stage I (35.2%), 5 as stage II (6.7%), 38 as stage III (51.4%) and one patient as stage IV. In 18 cases a segment of the portal vein was resected, in 16 cases reconstructed by end-to-end anastomosis and in two cases by implantation of a GoreTex prosthesis. No special anticoagulation was applied.


RESULTS
There were no anastomosis-related complications such as hemorrhage, thrombosis or stenosis. The lethality rate was 1.4% (1/74), insufficiencies at the pancreas and bile duct anastomosis occurred in 0% and 1.4% (1/74), resp. Patients with segmental vessel resection in stage III had a mean survival of 9 months and by 3 years there was no survivor compared to 11.7 months and 17% survival after 4 years in stage III without vessel resection.


CONCLUSIONS
By performing vessel resection more pancreas tumors than earlier are resectable without increased risk. Since the results of oncologic alternative treatment modalities are still poor pancreas resection represents at present the best option for the patient.
Keck
H
H
Chirurgische Klinik und Poliklinik, Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin.
Knoop
M
M
Langrehr
J M
JM
Henneken
V
V
Neuhaus
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery