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Minerva Chirurgica 2014 December;69(6):301-13


lingua: Inglese

Impact of a portal/superior mesenteric vein resection during pancreatico-duodenectomy for pancreatic head adenocarcinoma

Dumitrascu T. 1, Dima S. 1, Brasoveanu V. 1, Stroescu C. 1, Herlea V. 2, Moldovan S. 3, Ionescu M. 1, Popescu I. 1

1 Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania; 2 Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania; 3 Department of Visceral and Digestive Surgery, St. Vincent de Paul Hospital, Lille, France


AIM: The impact of venous resection (VR) in pancreatico-dudenectomy (PD) for pancreatic adenocarcinoma (PDAC) is controversial. The aim of the study is to comparatively assess the postoperative outcomes after PD with and without VR for PDAC and to identify predictors of morbidity and survival in the subgroup of PD with VR.
METHODS: The data of 51 PD with VR were compared with those of 183 PD without VR. Binary logistic regression and Cox survival analyses were performed.
RESULTS: Both the operative time and estimated blood loss was significantly higher in the VR group (P<0.001). A trend towards an increased 90-day mortality (9.8% vs. 5.5%) and severe morbidity (20% vs. 13%) was observed when a VR was performed (P ≥0.264). The median overall survival time after the PD with and without VR was 13 months and 17 months, respectively (P=0.845). The absence of histological tumor invasion of the VR was found as the only independent predictor for a better survival (HR=0.359; 95% CI 0.161-0.803; P=0.013).
CONCLUSION: A PD with VR can be safely incorporated in a pancreatic surgeon armamentarium. However, the trend towards increased mortality and severe morbidity rates should be expected, along with higher operative time and blood loss, compared with PD without VR. Associated VR does not appear to significantly impair the prognosis after PD for PDAC; however, histological tumor invasion of the VR has a negative impact on the survival.

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