Pancreatectomy combined with superior mesenteric-portal vein resection: report of 32 cases.
BACKGROUND: Resection of the superior mesenteric-portal vein (SMPV) during pancreatoduodenectomy is disputed. Although the morbidity and mortality of patients after this operation are acceptable, survival is limited. In this study, we evaluated the morbidity, mortality and survival of patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with en bloc portal vein resection. METHODS: A total of 32 patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with SMPV resection between 1999 and 2003 were retrospectively analyzed. In addition, they were categorized into two groups according to the invasion of the wall of the portal vein: group A (n=12),extended compression of the wall of the portal vein by surrounding carcinoma without true invasion and group B (n=20), true invasion including intramural and transmural invasion. RESULTS: The morbidity of the 32 patients was 31.25%. There was no operative death, and the overall 1-,3-year survival rates were 59% and 16%, respectively. The mean survival time of patients with microscopically positive margin was only 5.6 months as compared with 20 months in patients with microscopically negative margin. No differences in tumor size, margin positivity, nodal positivity, and 1-, 3-year survival rates were observed between the two groups. CONCLUSIONS: If selected carefully, pancreatectomy combined with SMPV resection can be performed safely, without increase in the morbidity and mortality. SMPV resection should be performed only when a margin-negative resection is expected to be achieved. SMPV invasion is not associated with histologic parameters suggesting a poor prognosis.