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

BackgroundWe 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.MethodsBetween 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°; 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.ResultsMorbidity 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 (n = 42) and 12 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 the 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 PVR, 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) despite similar positive rates of histologic venous invasion.ConclusionPVR has comparable survival compared with no PVR only in patients undergoing an R0 resection. The short PV/SMV invasion that requires PVR <3 cm in length can result in respectable survival rates.