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Results of pancreatic resection associated with portal vein resection in an A ustralian tertiary care centre
Author(s) -
Iorgulescu Dragos G.,
Ling Sophia,
Nikfarjam Mehrdad,
Fink Michael A.,
Jones Robert,
Muralidharan Vijayaragavan,
Starkey Graham,
Christophi Christopher
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.12585
Subject(s) - medicine , pancreatectomy , surgery , pancreatic cancer , retrospective cohort study , portal vein thrombosis , thrombosis , pathological , demographics , pancreas , portal vein , resection , cancer , demography , sociology
Background Portal vein resection ( PVR ) with pancreatectomy is now accepted practice in cases with involvement by tumour. We present our experience of this procedure with particular emphasis on morbidity and survival. Methods A retrospective case‐control analysis of a prospectively maintained database between 2004 and 2012 was undertaken. A total of 17 patients had pancreatic resections with PVR for cancer and were compared with 17 patients with identical tumour type and stage who underwent pancreatic resection without PVR next in chronological order. Information obtained included patient demographics, radiological and histological evidence of major vein involvement and post‐operative morbidity. Disease‐ and recurrence‐free survival were calculated using K aplan– M eier curves. Results Procedures associated with PVR included pancreatico‐duodenectomy in 11 and total pancreatectomy in six. Three patients underwent pancreatic resection as a re‐operation. Pathological staging showed 2× T2N0 , 5× T3N0 , 1× T1N1 , 2× T2N1 and 7× T3N1 tumours. Seven PVR patients (41%) had post‐operative morbidity C lavien 3 and 4, compared with none in no‐ PVR group, but rates of C lavien 1 and 2 complications were similar. Six PVR patients developed PV thrombosis (35%), all with significant clinical consequences. Comparing the PVR group with the no‐ PVR group, there was significantly reduced median overall survival in (13.8 versus 43.1 months; P = 0.028) and recurrence‐free survival (7.5 months versus 39.7; P = 0.004). Conclusions Survival of patients after pancreatectomy with PVR was reduced and morbidity was high compared with no‐ PVR . Delayed portal vein thrombosis due to recurrence was common. Routine post‐operative anticoagulation may be indicated in this group.