title: Significance of pathological positive superior mesenteric/portal venous invasion in pancreatic cancer.
abstract: BACKGROUND
  Pancreaticoduodenectomy with superior mesenteric/portal venous resection for pancreatic ductal adenocarcinoma (PDAC) is frequently performed with no added morbidity or mortality in case of tumor abutment to the superior mesenteric or portal vein so as to obtain a margin negative resection. True histopathological portal vein invasion is found only in a small subset of such patients. The aim of this review aimed to discuss the significance of histopathological venous invasion in PDAC.
  
  
  METHODS
  For this review available data was searched from PubMed and analyzed. No randomized trials have been published on this topic.
  
  
  RESULTS
  Existing data on prognostic factors in histopathological venous invasion by PDAC are limited and recent studies indicate worse survival in this subgroup of patients. In addition, venous invasion in PDAC has been associated with large tumors, involved lymph nodes, perineural invasion and R1 resection. The survival of patients with portal venous resection but without histologic venous invasion is reportedly better than those with histopathological venous invasion; though conflicting studies do exist on the subject. Some studies also relate the depth of venous invasion to prognosis after surgical resection of PDAC.
  
  
  CONCLUSIONS
  Frank/'histopathological' invasion of superior mesenteric/portal venous and R1 resection indicate a very poor survival. Such patients may be given the opportunity of benefit of neoadjuvant treatment.
authors.affiliation: Hepato Pancreatico Biliary and Gastrointestinal Division, Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005 U.P., India. drmtewari@gmail.com.
authors.forename: Mallika
authors.initials: M
authors.lastname: Tewari
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008642:Mesenteric Veins / Q000473:pathology* / Q000601:surgery; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome