title: Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer.
abstract: OBJECTIVE
  The purpose of this study was to determine the significance of portal vein-superior mesenteric vein (PV-SMV) invasion on survival in patients who underwent margin-negative pancreatoduodenectomy (PD) with PV-SMV resection for pancreatic adenocarcinoma.
  
  
  METHODS
  We retrospectively reviewed the records of 60 patients who underwent margin-negative PD with or without PV-SMV resection for pancreatic adenocarcinoma between August 2001 and December 2007. The depth of vessel invasion was investigated and was categorized into 3 groups: tunica adventitia, media, and intima. Clinicopathologic factors and survival were analyzed.
  
  
  RESULTS
  Portal vein-superior mesenteric vein resection was performed on 19 patients, but only 15 patients (78.9%) had histologically true invasion and showed poorer survival (median survival, 14 vs 9 months; P < 0.05). Univariate analysis revealed that poorly differentiated tumor, lymphatic invasion, endovascular invasion, PV-SMV invasion, and invasion into the intima of PV-SMV were statistically significant. Poorly differentiated tumor and invasion into the intima of PV-SMV were significant in multivariate analysis.
  
  
  CONCLUSIONS
  Aggressive surgical resection should be attempted in cases with suspected PV-SMV invasion because 21.1% of patients had no true invasion and showed better survival than those with true invasion. However, invasion into the tunica intima may be a poor prognostic factor for survival even after margin-negative PD for pancreatic adenocarcinoma.
authors.affiliation: Center for Liver Cancer, National Cancer Center, Gyeonggi-do, Korea.
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Cho
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Soon-ae
authors.initials: SA
authors.lastname: Lee
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Hong
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017539:Tunica Intima / Q000473:pathology / Q000601:surgery; D017540:Tunica Media / Q000473:pathology / Q000601:surgery