Long‐term outcome of portomesenteric vein invasion and prognostic factors in pancreas head adenocarcinoma

Background The purpose of this study was to clarify the post‐operative prognosis of pancreatic head cancer with pathologic portal vein ( PV ) or superior mesenteric vein ( SMV ) invasion. Methods From M ay 1995 to D ecember 2009, preoperative, intra‐operative and post‐operative data from 276 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma were reviewed retrospectively. The long‐term prognosis was compared between patients with a pathologic PV ‐ SMV invasion and those without invasion. Results Fourty‐six patients (16.7%) underwent PV ‐ SMV resection during pancreaticoduodenectomy. Pathologic PV ‐ SMV invasion was observed in 30 (65.2%). Post‐operative severe morbidity (grade 3 or 4) was similar for patients with and without PV ‐ SMV resection (8.7% with versus 7.0% without P  = 0.754). The mortality rate was 2.2% with PV ‐ SMV resection and 0.9% without PV ‐ SMV resection ( P  = 0.423). Survival of PV ‐ SMV resection and no resection group had no significant difference (median survival, 16 versus 12 months; P  = 0.086). No significant difference in overall survival was seen between patients with and without pathologic PV ‐ SMV invasion (median survival, 13 versus 16 months; P  = 0.663). Tumour differentiation, R status, tumour size and type of operation were revealed as independent prognostic factors. Conclusions 34.8% of patients who underwent PV ‐ SMV resection had no pathologic invasion. And PV ‐ SMV resection did not increase the rate of severe complications and mortality. Furthermore, the prognosis for patients with pathologic PV ‐ SMV invasion may be nearly the same as patients with no invasion. So, PV ‐ SMV resection with reconstruction should be considered in pancreatic head cancer patients with suspected PV ‐ SMV invasion.