Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma

• Published in: British journal of surgery 2017-10, Vol.104 (11), p.1549-1557
• Main Authors: Maeta, T., Ebata, T., Hayashi, E., Kawahara, T., Mizuno, S., Matsumoto, N., Ohta, S., Nagino, M., Aoba, T., Kaneoka, Y., Arai, T., Shimizu, Y., Kiriyama, M., Sakamoto, E., Miyake, H., Takara, D., Shirai, K., Ohira, S., Morofuji, N., Akutagawa, A., Yamaguchi, R., Takano, M., Yamamoto, H., Inoue, M., Asaba, Y., Watanabe, T., Hashimoto, M., Kawai, S., Ikuta, K., Matsubara, H., Kato, K., Kondo, S.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Blood Loss, Surgical; Blood Transfusion - statistics & numerical data; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Female; Follow-Up Studies; Humans; Japan - epidemiology; Lymphatic Metastasis; Lymphatic system; Male; Margins of Excision; Medical prognosis; Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Operative Time; Pancreaticoduodenectomy; Portal Vein - surgery; Retrospective Studies; Veins & arteries
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.10596

Background Little is known about the value of portal vein (PV) resection in distal cholangiocarcinoma. The aim of this study was to evaluate the clinical significance of PV resection in distal cholangiocarcinoma. Methods Patients who underwent pancreatoduodenectomy (PD) for distal cholangiocarcinoma between 2001 and 2010 at one of 31 hospitals in Japan were reviewed retrospectively with special attention to PV resection. Short‐ and long‐term outcomes were evaluated. Results In the study interval, 453 consecutive patients with distal cholangiocarcinoma underwent PD, of whom 31 (6·8 per cent) had combined PV resection. The duration of surgery (510 versus 427 min; P = 0·005) and incidence of blood transfusion (48 versus 30·7 per cent; P = 0·042) were greater in patients who had PV resection than in those who did not. Postoperative morbidity and mortality were no different in the two groups. Several indices of tumour progression, including high T classification, lymphatic invasion, perineural invasion, pancreatic invasion and lymph node metastasis, were more common in patients who had PV resection. Consequently, the incidence of R1/2 resection was higher in this group (32 versus 11·8 per cent; P = 0·004). Survival among the 31 patients with PV resection was worse than that for the 422 patients without PV resection (15 versus 42·4 per cent at 5 years; P