[Is pancreatectomy with resection of the retro-pancreatic vessels for cancer justified?].
OBJECTIVE
Tumoural invasion of the retropancreatic vessels and particularly of the superior mesentericoportal vein confluence (SMPV) is often considered as a contraindication to resection of malignant tumours of the pancreas. The aim of this retrospective study is to report a series of 20 patients and to demonstrate that resection of the vessels supposed to be involved is justified when it is the only barrier to a complete tumoural resection.


METHODS
Twenty patients, 11 men and nine women (mean age: 61.7 years) underwent a right (n = 14), left (n = 2) or total (n = 4) pancreatic resection for pancreatic adenocarcinoma (n = 19) or cystadenocarcinoma (n = 1) associated with partial resection of SMPV (n = 17), inferior vena cava (n = 1), right hepatic artery (n = 1) and common hepatic artery (n = 1). The veins were reconstructed in all cases by end to end anastomosis and the arteries by direct suture in one patient and venous or artery graft in two patients.


RESULTS
Tumoural invasion was histologically present in the vascular wall in nine patients, in the perivascular area in six and negative in five. The in-hospital mortality was nil. One patient had an early venous thrombosis of the repaired SMPV which was reoperated and treated with success by desobstruction and venous graft. The 3-year actuarial survival rate was 16%.


CONCLUSIONS
Segmental venous resection of the SMPV confluence can be performed safely. Localised invasion of the vascular wall, considered as the only obstacle for a complete tumoural resection, is not associated with a poor prognosis. In case of tight adhesions between tumour and SMPV (inflammatory or tumoural) the venous resection may be included in a deliberate surgical strategy. On the other hand, total obstruction of SMPV, extrapancreatic tumoural extension, tumoural invasion of superior mesenteric artery or coeliac trunk are contraindications to pancreatic resection.
Baulieux
J
J
Service de chirurgie générale digestive et de transplantation hépatique, hôpital de la Croix-Rousse, Lyon, France.
Adham
M
M
Oussoultzoglou
E
E
De la Roche
E
E
Berthoux
N
N
Bourdeix
O
O
Ducerf
C
C
D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002445:Celiac Artery / Q000473:pathology; D000075202:Contraindications; D003536:Cystadenocarcinoma / Q000473:pathology / Q000601:surgery; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000601:surgery; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000098:blood supply*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D014680:Veins / Q000637:transplantation; D014682:Vena Cava, Inferior / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery