title: Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review.
abstract: OBJECTIVE
  This systematic review objectively evaluates the safety and outcomes of extended pancreaticoduodenectomy with vascular resection for pancreatic cancer involving critical adjacent vessels namely the superior mesenteric-portal veins, hepatic artery, superior mesenteric artery, and celiac axis.
  
  
  METHODS
  Electronic searches were performed on two databases from January 1995 to August 2009. The end points were: firstly, to evaluate the safety through reporting the mortality rate and associated complications and, secondly, the outcome by reporting the survival after surgery. This was synthesized through a narrative review with full tabulation of results of all included studies.
  
  
  RESULTS
  Twenty-eight retrospective studies comprising of 1,458 patients were reviewed. Vein thrombosis and arterial involvement were reported as contraindications to surgery in 62% and 71% of studies, respectively. The median mortality rate was 4% (range, 0% to 17%). The median R0 and R1 rates were 75% (range, 14% to 100%) and 25% (range, 0% to 86%), respectively. In high volume centers, the median survival was 15 months (range, 9 to 23 months). Nine of 10 (90%) studies comparing the survival after extended pancreaticoduodenectomy with vascular resection versus standard pancreaticoduodenectomy reported statistically similar (p > 0.05) survival outcomes. Undertaking vascular resection was not associated with a poorer survival.
  
  
  CONCLUSIONS
  The morbidity, mortality, and survival outcome after undertaking extended pancreaticoduodenectomy with vascular resection for pancreatic cancer with venous involvement and/or limited arterial involvement is acceptable in the setting of an expert referral center and should not be a contraindication to a curative surgery.
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, Kogarah, NSW 2217, Sydney, Australia. terence.chua@unsw.edu.au
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
mesh_terms: D006801:Humans; D010179:Pancreas / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*