title: Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability.
abstract: OBJECTIVE
  To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.
  
  
  METHODS
  Between January 2001 and March 2012, 136 patients received pancreaticoduodenectomy for adenocarcinoma at our hospital. Seventy-eight patients diagnosed with pancreatic head carcinoma were included in this study. Among them, 46 patients received standard pancreaticoduodenectomy (group 1) and 32 patients received pancreaticoduodenectomy with simultaneous resection of the portal vein or the superior mesenteric vein or artery (group 2) followed by reconstruction. The immediate surgical outcomes and survivals were compared between the groups. Fifty-five patients with unresectable adenocarcinoma of the pancreas without liver metastasis who received only bypass operations (group 3) were selected for additional survival comparison.
  
  
  RESULTS
  The median ages of patients were 67 years (range: 37-82 years) in group 1, and 63 years (range: 35-86 years) in group 2. All group 2 patients had resection of the portal vein or the superior mesenteric vein and three patients had resection of the superior mesenteric artery. The pancreatic fistula formation rate was 21.7% (10/46) in group 1 and 15.6% (5/32) in group 2 (P = 0.662). Two hospital deaths (4.3%) occurred in group 1 and one hospital death (3.1%) occurred in group 2 (P = 0.641). The one-year, three-year and five-year overall survival rates in group 1 were 71.1%, 23.6% and 13.5%, respectively. The corresponding rates in group 2 were 70.6%, 33.3% and 22.2% (P = 0.815). The one-year survival rate in group 3 was 13.8%. Pancreaticoduodenectomy with simultaneous vascular resection was safe for pancreatic head adenocarcinoma.
  
  
  CONCLUSIONS
  The short-term and survival outcomes with simultaneous resection were not compromised when compared with that of standard pancreaticoduodenectomy.
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Simon H Y
authors.initials: SH
authors.lastname: Tsang
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Wing Chiu
authors.initials: WC
authors.lastname: Dai
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.affiliation: Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: Adjuvant therapy; Head of pancreas; Liver transplant; Morbidity; Mortality; Portal vein resection; Survival analysis; Whipple operation