Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy.
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.
van Geenen
R C
RC
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
ten Kate
F J
FJ
de Wit
L T
LT
van Gulik
T M
TM
Obertop
H
H
Gouma
D J
DJ
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001652:Bile Ducts; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality; D011169:Portal Vein / Q000601:surgery*; D011446:Prospective Studies; D016019:Survival Analysis