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Vascular resection during radical resection of pancreatic adenocarcinomas: evolution over the past 15 years
Author(s) -
Ouaïssi Mehdi,
Turrini Olivier,
Hubert Catherine,
Louis Guillaume,
Gigot JeanFrançois,
Mabrut JeanYves
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.122
Subject(s) - medicine , pancreatectomy , resection , adenocarcinoma , population , pancreatic cancer , survival rate , surgery , mortality rate , vascular invasion , pancreas , cancer , environmental health
This literature review aimed to critically analyze oncological results of vascular resection during pancreatectomy for adenocarcinoma in the light of the concept evolution of locally advanced tumors and microscopic complete resection. The literature search was conducted in PubMed and M edline for the period J une 1994 to D ecember 2012, retaining E nglish as the language of publication. The review of 12 publications indicated that mortality and morbidity rates were not significantly different for pancreatectomy with or without venous resection ( VR ). Six comparative studies showed worse long‐term survival in the VR group, though one meta‐analysis, albeit with a significant population heterogeneity, demonstrated that the overall survival between VR and the control group was similar (12% vs. 17%). The compilation of 13 comparative studies showed a significantly lower rate of complete microscopic resection in the VR patient group compared to controls (63% vs. 77%; P = 0.001). Concerning pancreatectomy combined to arterial resection, the literature review indicated a significantly greater mortality and morbidity rate and a lower survival rate compared to pancreatic resection alone. Conflicting results concerning the long‐term outcome of VR was due to the heterogeneity of the patient population. Since the only chance to cure patients of pancreatic adenocarcinoma is to obtain free resection margins, VR is a valid therapeutic option. But combined arterial resection to pancreatic resection does not appear to be recommended.