Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. BJS 2017; 104: 1539-1548.
Published: 22nd August 2017
Authors: R. Ravikumar, C. Sabin, M. Abu Hilal, A. Al‐Hilli, S. Aroori, G. Bond‐Smith et al.
The International Study Group of Pancreatic Surgery (ISGPS) recommends operative exploration and resection of pancreatic cancers in the presence of reconstructable mesentericoportal axis involvement. However, there is no consensus on the ideal method of vascular reconstruction. The effect of depth of tumour invasion of the vessel wall on outcome is also unknown.
This was a retrospective cohort study of pancreaticoduodenectomy with vein resection for T3 adenocarcinoma of the head of the pancreas across nine centres. Outcome measures were overall survival based on the impact of the depth of tumour infiltration of the vessel wall, and morbidity, in‐hospital mortality and overall survival between types of venous reconstruction: primary closure, end‐to‐end anastomosis and interposition graft.
A total of 229 patients underwent portal vein resection; 129 (56·3 per cent) underwent primary closure, 64 (27·9 per cent) had an end‐to‐end anastomosis and 36 (15·7 per cent) an interposition graft. There was no difference in overall morbidity (26 (20·2 per cent), 14 (22 per cent) and 9 (25 per cent) respectively;
In this study, there was no difference in morbidity between the three modes of venous reconstruction, and overall survival was similar regardless of tumour infiltration of the vein.Read more
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