title: [Pancreatic carcinoma presenting with invasion of the vena porta or the superior mesenteric vein: our experience and review of the literature].
abstract: OBJECTIVE
  Adenocarcinoma of the pancreas can present with invasion of the vena porta or the superior mesenteric vein (SMV). Pancreatectomy with resection of the vena porta and/or the SMV remains controversial although the procedure is potentially curative. The aim of this study was to validate the indication for resection on the basis of our experience and evidence from recently published studies.
  
  
  METHODS
  Studies published in the last 10 years on pancreatectomy (duodenocephalopancreatectomy, total and distal pancreatectomy) with resection of the vena porta and/or the SMV were retrieved from the Medline database and reviewed. A total of 18 studies meeting the inclusion criteria were analyzed for information about indications, type of intervention, use of adjuvant therapies, histopathology, perioperative results and survival in 620 patients with adenocarcinoma of the pancreas undergoing pancreatectomy with resection of the vena porta and the SMV. This data set was then compared with our experience with this procedure from the last 3 years.
  
  
  RESULTS
  The mortality and postoperative complication rates varied between 0% and 7.7% and 12.5% and 54%, respectively. The median survival varied from 12 to 22 months; the 1 year survival rate was between 31% and 83%; the 5-year survival rate was between 9 and 18% according to the studies reviewed.
  
  
  CONCLUSIONS
  On the basis of evidence from the literature and our experience, en bloc resection of the vena porta and/or the SMV during pancreatectomy appears to be a safe procedure with acceptable outcomes, and should be considered in patients with pancreatic cancer presenting with venous invasion. Venous resection increases the surgical cure rate, prolonging survival in patients selected according to correct indications.
authors.affiliation: Università Sapienza di Roma, II Facoltà di Medicina, Ospedale Sant'Andrea, Roma, Italia.
authors.forename: G
authors.initials: G
authors.lastname: Ramacciato
authors.forename: P
authors.initials: P
authors.lastname: Mercantini
authors.forename: N
authors.initials: N
authors.lastname: Petrucciani
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.forename: G
authors.initials: G
authors.lastname: Nigri
authors.forename: P
authors.initials: P
authors.lastname: Aurello
authors.forename: F
authors.initials: F
authors.lastname: D'Angelo
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: M
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008642:Mesenteric Veins / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery*; D019043:Vascular Neoplasms / Q000601:surgery*