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Outcomes of pancreaticoduodenectomy with venous resection: a single center experience with 11 cases

Year 2023, Volume: 4 Issue: 2, 74 - 78, 27.03.2023
https://doi.org/10.47582/jompac.1206468

Abstract

Aim: To perform a retrospective evaluation of the morbidity and mortality rates and reliability of venous resection with pancreaticoduodenectomy (PD) procedures in our clinic.
Material and Method: The records of 11 patients who underwent PD with venous resection between May 2016 and May 2021 in the Eskişehir Osmangazi University Faculty of Medicine Department of General Surgery were analyzed retrospectively.
Results: Eleven patients (five women and six men) were included. The patients’ mean age was 64.09±9.27 years (range 47-78). Four (36.36%) patients underwent type 1 reconstruction, one (9.09%) type 2 reconstruction, five (45.45%) type 3 reconstruction and one (9.09%) type 4 reconstruction. Eight (72.73%) patients experienced venous invasion according to the histopathology reports. Mean time between diagnosis and surgery was 14.91±11.33 days, and the mean follow-up time was 17.64±13.31 months. Grade C pancreatic fistula was observed in one (9.09%) patient, who died on the 17th postoperative day. No patients experienced recurrence or metastasis during surveillance.
Conclusion: Pancreaticoduodenectomy with venous resection-reconstruction is safe and the only curative option in patients with pancreatic cancer and venous invasion.

Supporting Institution

None

References

  • Birkmeyer JD, Sun Y, Wong SL, et al. Hospital volume and late survival after cancer surgery. Annals of Surgery 2007; 245: 777-83.
  • Fong Y, Gonen M, Rubin D, et al. Long-term survival is superior after resection for cancer in high-volume centers. Annals of Surgery 2005; 242: 540-4; discussion 4-7.
  • Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Annals of Surgery 2006; 244: 10-5.
  • Maley WR, Yeo CJ. Vascular Resections During the Whipple Procedure. Advances in Surgery 2017; 51: 41-63.
  • Moore GE, Sako Y, Thomas LB. Radical pancreatoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery 1951; 30: 550-3.
  • Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology. J National Comprehensive Cancer Network 2021; 19: 439-57.
  • Kakar S, Pawlik T, Allen P. Exocrine pancreas. AJCC Cancer Staging Manual 8 ed: AJCC; 2017. p. 337.
  • Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2014; 155: 977-88.
  • Sgroi MD, Narayan RR, Lane JS, et al. Vascular reconstruction plays an important role in the treatment of pancreatic adenocarcinoma. J Vascular Surg 2015; 61: 475-80.
  • Barreto SG, Windsor JA. Justifying vein resection with pancreatoduodenectomy. The Lancet Oncology 2016; 17: e118-e24.
  • Xie ZB, Gu JC, Zhang YF, et al. Portal vein resection and reconstruction with artificial blood vessels is safe and feasible for pancreatic ductal adenocarcinoma patients with portal vein involvement: Chinese center experience. Oncotarget 2017; 8: 77883-96.
  • Wagner M, Redaelli C, Lietz M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. British J Surg 2004; 91: 586-94.
  • Martin RC, 2nd, Scoggins CR, Egnatashvili V, et al. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Archives of Surgery (Chicago, Ill : 1960) 2009; 144: 154-9.
  • Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 2009; 13: 784-92.
  • Tashiro S, Uchino R, Hiraoka T, et al. Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Surgery 1991; 109: 481-7.
  • Ishikawa O, Ohigashi H, Imaoka S, et al. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Annals of Surgery 1992; 215: 231-6.
  • Takahashi S, Ogata Y, Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer. British J Surg 1994; 81: 1190-3.
  • Allema JH, Reinders ME, van Gulik TM, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. British J Surg 1994; 81: 1642-6.
  • Nakao A, Harada A, Nonami T, et al. Clinical significance of portal invasion by pancreatic head carcinoma. Surgery 1995; 117: 50-5.
  • Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996; 171: 170-4; discussion 4-5.
  • Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Annals of Surgery 1996; 223: 154-62.
  • Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Annals of Surgery 1996; 224: 342-7; discussion 7-9.
  • Clavien PA, Rüdiger HA. A simple technique of portal vein resection and reconstruction during pancreaticoduodenectomy. J Am College of Surgeons 1999; 189: 629-34.
  • Schäfer M, Müllhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Annals of Surgery 2002; 236: 137-48.
  • Chu CK, Farnell MB, Nguyen JH, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Colllege of Surgeons 2010; 211: 316-24.
  • Cherukuru R, Govil S, Vij M, et al. Vein resection in patients with adenocarcinoma of the head of pancreas adherent to the portomesenteric venous axis is beneficial despite a high rate of R1 resection. Annals of Hepato-biliary-pancreatic Surg 2018; 22: 261-8.
  • Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. British J Surg 2017; 104: 1539-48.

Venöz rezeksiyonlu pankreatikoduodenektomi sonuçları: 11 olgu ile tek merkez deneyimi

Year 2023, Volume: 4 Issue: 2, 74 - 78, 27.03.2023
https://doi.org/10.47582/jompac.1206468

Abstract

Amaç: Kliniğimizde venöz rezeksiyonlu pankreatikoduodenektomi (PD) uygulanan hastalarda morbidite ve mortalite oranlarının ve prosedürün güvenilirliğinin retrospektif olarak değerlendirilmesi.
Gereç ve Yöntem: XXX Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda Mayıs 2016-Mayıs 2021 tarihleri arasında venöz rezeksiyon ile PD uygulanan 11 hastanın kayıtları retrospektif olarak incelendi.
Bulgular: On bir hasta (beş kadın, altı erkek) çalışmaya dahil edildi. Hastaların yaş ortalaması 64,09 ± 9.27 (47-78) idi. Dört (%36,36) hastaya tip 1, bir (%9,09) hastaya tip 2, beş (%45,45) hastaya tip 3 ve bir (%9,09) hastaya tip 4 rekonstrüksiyon uygulandı. Histopatoloji raporlarına göre sekiz (%72,73) hastada venöz invazyon saptandı. Tanı ile operasyon arasındaki ortalama süre 14,91 ± 11,33 gün, ortalama takip süresi 17,64 ± 13,31 aydı. Postoperatif 17. günde exitus olan bir hastada (%9,09) Grade C pankreas fistülü izlendi. Takipte hiçbir hastada nüks veya metastaz saptaanmadı.
Sonuç: Venöz rezeksiyon-rekonstrüksiyonlu PD, pankreas kanseri ve venöz invazyonu olan hastalarda güvenli ve tek küratif seçenektir.

References

  • Birkmeyer JD, Sun Y, Wong SL, et al. Hospital volume and late survival after cancer surgery. Annals of Surgery 2007; 245: 777-83.
  • Fong Y, Gonen M, Rubin D, et al. Long-term survival is superior after resection for cancer in high-volume centers. Annals of Surgery 2005; 242: 540-4; discussion 4-7.
  • Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Annals of Surgery 2006; 244: 10-5.
  • Maley WR, Yeo CJ. Vascular Resections During the Whipple Procedure. Advances in Surgery 2017; 51: 41-63.
  • Moore GE, Sako Y, Thomas LB. Radical pancreatoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery 1951; 30: 550-3.
  • Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology. J National Comprehensive Cancer Network 2021; 19: 439-57.
  • Kakar S, Pawlik T, Allen P. Exocrine pancreas. AJCC Cancer Staging Manual 8 ed: AJCC; 2017. p. 337.
  • Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2014; 155: 977-88.
  • Sgroi MD, Narayan RR, Lane JS, et al. Vascular reconstruction plays an important role in the treatment of pancreatic adenocarcinoma. J Vascular Surg 2015; 61: 475-80.
  • Barreto SG, Windsor JA. Justifying vein resection with pancreatoduodenectomy. The Lancet Oncology 2016; 17: e118-e24.
  • Xie ZB, Gu JC, Zhang YF, et al. Portal vein resection and reconstruction with artificial blood vessels is safe and feasible for pancreatic ductal adenocarcinoma patients with portal vein involvement: Chinese center experience. Oncotarget 2017; 8: 77883-96.
  • Wagner M, Redaelli C, Lietz M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. British J Surg 2004; 91: 586-94.
  • Martin RC, 2nd, Scoggins CR, Egnatashvili V, et al. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Archives of Surgery (Chicago, Ill : 1960) 2009; 144: 154-9.
  • Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 2009; 13: 784-92.
  • Tashiro S, Uchino R, Hiraoka T, et al. Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Surgery 1991; 109: 481-7.
  • Ishikawa O, Ohigashi H, Imaoka S, et al. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Annals of Surgery 1992; 215: 231-6.
  • Takahashi S, Ogata Y, Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer. British J Surg 1994; 81: 1190-3.
  • Allema JH, Reinders ME, van Gulik TM, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. British J Surg 1994; 81: 1642-6.
  • Nakao A, Harada A, Nonami T, et al. Clinical significance of portal invasion by pancreatic head carcinoma. Surgery 1995; 117: 50-5.
  • Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996; 171: 170-4; discussion 4-5.
  • Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Annals of Surgery 1996; 223: 154-62.
  • Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Annals of Surgery 1996; 224: 342-7; discussion 7-9.
  • Clavien PA, Rüdiger HA. A simple technique of portal vein resection and reconstruction during pancreaticoduodenectomy. J Am College of Surgeons 1999; 189: 629-34.
  • Schäfer M, Müllhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Annals of Surgery 2002; 236: 137-48.
  • Chu CK, Farnell MB, Nguyen JH, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Colllege of Surgeons 2010; 211: 316-24.
  • Cherukuru R, Govil S, Vij M, et al. Vein resection in patients with adenocarcinoma of the head of pancreas adherent to the portomesenteric venous axis is beneficial despite a high rate of R1 resection. Annals of Hepato-biliary-pancreatic Surg 2018; 22: 261-8.
  • Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. British J Surg 2017; 104: 1539-48.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Dursun Burak Özdemir 0000-0002-3672-5738

Ahmet Karayiğit 0000-0003-0380-9190

Hayrettin Dizen 0000-0002-4031-2557

Ümit Özdemir 0000-0001-5681-7421

İhsan Burak Karakaya 0000-0001-7634-0771

Barış Türker 0000-0002-4469-1558

Cüneyt Akyüz 0000-0002-5904-701X

Murat Ulaş 0000-0002-3507-8647

İlter Ozer 0000-0001-6902-0913

Bülent Ünal 0000-0003-2538-7961

Publication Date March 27, 2023
Published in Issue Year 2023 Volume: 4 Issue: 2

Cite

AMA Özdemir DB, Karayiğit A, Dizen H, Özdemir Ü, Karakaya İB, Türker B, Akyüz C, Ulaş M, Ozer İ, Ünal B. Outcomes of pancreaticoduodenectomy with venous resection: a single center experience with 11 cases. J Med Palliat Care / JOMPAC / jompac. March 2023;4(2):74-78. doi:10.47582/jompac.1206468

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