Carcinoma of the periampullary region: Who benefits from portal vein resection?

The prognosis of patients with carcinoma of the periampullary region infiltrating the portal vein is dismal. We assessed the morbidity, mortality, and prognosis of pancreatoduodenectomy in 31 patients in whom a tangential excision (n = 9) or a segmental resection (n = 22) of the portal vein or super...

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Bibliographic Details
Published in:The American journal of surgery 1996, Vol.171 (1), p.170-175
Main Authors: Roder, Jürgen D., Stein, Hubert J., Siewert, J. Rüdiger
Format: Article
Language:English
Subjects:
Adult
Aged
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - surgery
Bile ducts
Biological and medical sciences
Cancer
Carcinoma - mortality
Carcinoma - surgery
Carcinoma, Acinar Cell - surgery
Cystadenocarcinoma - surgery
Female
Humans
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical prognosis
Medical sciences
Mesenteric Veins - surgery
Metastases
Middle Aged
Morbidity
Mortality
Pancreatic carcinoma
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Portal vein
Portal Vein - surgery
Prognosis
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival
Tumors
Veins
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Summary:The prognosis of patients with carcinoma of the periampullary region infiltrating the portal vein is dismal. We assessed the morbidity, mortality, and prognosis of pancreatoduodenectomy in 31 patients in whom a tangential excision (n = 9) or a segmental resection (n = 22) of the portal vein or superior mesenteric vein was performed in an attempt to achieve complete tumor removal. There was no postoperative mortality. Tumor infiltration of the resected vein could be documented histopathologically in 19 of the 31 (61.3%) patients. All patients with pancreatic or bile duct carcinoma (n = 29) died within 16 months of the resection (median survival 8 months). In contrast, 2 patients with cystadenocarcinoma and acinous cell carcinoma are alive with no evidence of recurrence at 23 and 54 months, respectively. Portal vein resection does not prolong survival in patients undergoing partial pancreatoduodenectomy for carcinoma of the pancreas or distal bile duct. Only the occasional patient with a rare tumor at this region may benefit from this approach.
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(99)80094-4