Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma?
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.
Ramacciato
Giovanni
G
Azienda Ospedaliera Sant'Andrea, UOC Hepatobiliary and Pancreatic Surgery, II Faculty of Medicine, University of Rome La Sapienza, Via di Grottarossa 1035-1039, Rome, Italy. giovanni.ramacciato@uniroma1.it
Mercantini
Paolo
P
Petrucciani
Niccolò
N
Giaccaglia
Valentina
V
Nigri
Giuseppe
G
Ravaioli
Matteo
M
Cescon
Matteo
M
Cucchetti
Alessandro
A
Del Gaudio
Massimo
M
D000368:Aged; D006801:Humans; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery* / Q000628:therapy; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D014656:Vascular Surgical Procedures