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Long‐term outcome of portomesenteric vein invasion and prognostic factors in pancreas head adenocarcinoma
Author(s) -
Jeong Jaehong,
Choi Dong W.,
Choi Seong H.,
Heo Jin S.,
Jang KeeTaek
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12502
Subject(s) - medicine , term (time) , pancreatic head , adenocarcinoma , radiology , oncology , pancreas , head (geology) , general surgery , surgery , cancer , physics , quantum mechanics , geomorphology , geology
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.