Carcinoma of the periampullary region: who benefits from portal vein resection?
BACKGROUND
The prognosis of patients with carcinoma of the periampullary region infiltrating the portal vein is dismal.


METHODS
We assessed the morbidity, mortality, and prognosis of pancreatoduodenectomy in 31 patients in whom a tangential excision (n = 9) or a segmental resection (n = 22) of the portal vein or superior mesenteric vein was performed in an attempt to achieve complete tumor removal.


RESULTS
There was no postoperative mortality. Tumor infiltration of the resected vein could be documented histopathologically in 19 of the 31 (61.3%) patients. All patients with pancreatic or bile duct carcinoma (n = 29) died within 16 months of the resection (median survival 8 months). In contrast, 2 patients with cystadenocarcinoma and acinous cell carcinoma are alive with no evidence of recurrence at 23 and 54 months, respectively.


CONCLUSIONS
Portal vein resection does not prolong survival in patients undergoing partial pancreatoduodenectomy for carcinoma of the pancreas or distal bile duct. Only the occasional patient with a rare tumor at this region may benefit from this approach.
Roder
J D
JD
Department of Surgery, Technische Universität München, Klinikum rechts der Isar, Germany.
Stein
H J
HJ
Siewert
J R
JR
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D018267:Carcinoma, Acinar Cell / Q000601:surgery; D003536:Cystadenocarcinoma / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011379:Prognosis