Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: Prognostic value of the length of venous resection

Background. We investigated retrospectively the operative outcomes of portal vein resection (PVR) for portal vein (PV) and/or superior mesenteric vein (SMV) involvement and clarified, the validity of PVR. Methods. Between 1993 and 2006, 84 patients with invasive pancreatic head adenocarcinoma were resected by pancreatoduodenectomy with. macroscopically curative resection. Forty-two patients underwent PVR. by means of segmental resection. with end-to-end anastomosis in 27 patients and autologous vein graft using an external iliac, vein in 15 patients because of macroscopic venous involvement. Venous involvement. was classified macroscopically as unilateral involvement (<= 180 degrees; n = 27) or circumferential involvement (n = 15) and as short (the length of PVR < 3 cm; n = 15) or long (>= 3 cm; n = 27). Histopathologic parameters and survival were analyzed to confirm prognostic factors. Results. Morbidity and mortality were not different based on PVR status. Median. and 5-year survivals were 26 months and 32%, respectively, when. there was no PVR (it = 42) and 72 months and 17% when there was PVR (n = 42); these values of median and 5-year survivals differed (P <.04 each) between the groups without and with PVR. Limiting tire analysis to R0 (histologically, curative) resections, median. and 5-year survivals were 26 months and 34 % when there was no PVR (n = 39) and 20 months and 23% when there was PVR (n = 32); these survivals were not significantly different between groups. In patients with PIA there were no statistical differences in survival between those resected with or without a venous allograft and those with unilateral or circumferential involvement; however;.short PVR showed better 5-year survival than long PVR (39 % vs 4 %; P =.017) desPVRe, similar positive rates of histologic venous invasion. Conclusion. PVR has comparable survival compared with, no PVR only in patients undergoing an R0 resection. The short PV/SMV invasion dial requires PVR <3 cm in length can, result in respectable survival rates. (Surgery 2009,145:417-25.)