Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with vascular resection : experience in Clinical Centre Maribor, Slovenia
Background: Recent reports have shown that patients with vascular tumor invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels.
Methods: Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 +- 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Current literature and our experience in pancreatectomies with en bloc vascular resection and reconstruction of portal vein are reviewed.
Results: 22 patients out of 133 (16.5%) had portal vein-superior mesenteric vein resection and portal vein reconstruction (PVR) during pancreaticoduodenectomy. In fourteen patients portal vein was reconstructed without use of synthetic vascular graft. In these series two types of venous reconstruction were performed. When tumor involvement was limited to the superior mesenteric vein (SPV) or portal vein (PV) such that the splenic vein could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed. When tumor involved the SMV –splenic vein confluence, splenic vein ligation was necessary. In the remaining eight procedures interposition graft were needed. Dacron grafts with 10 mm diameter were used. There was no infection after dacron grafting. One patient had portal vein thrombosis after surgery: it was thrombosis after primary reconstruction. There were no thromboses in patients with synthetic graft interposition. There were no significant differences in the length of surgery, length of hospitalization , postoperative morbidity or grades of complication between group of patients with or without PVR.Conclusion: Survival of patients with pancreatic cancer who undergo an R0 resection with reconstruction is comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Synthetic graft appeared to be an effective and safe option as an interposition graft for portomesenteric venous reconstruction after pancreaticoduodenectomy.