Does Portal-Superior Mesenteric Vein Invasion Still Indicate Irresectability for Pancreatic Carcinoma?

Azienda Ospedaliera Sant'Andrea, UOC Hepatobiliary and Pancreatic Surgery, II Faculty of Medicine, University of Rome La Sapienza, Via di Grottarossa 1035-1039, Rome, Italy.
Annals of Surgical Oncology (Impact Factor: 3.93). 02/2009; 16(4):817-25. DOI: 10.1245/s10434-008-0281-8
Source: PubMed


Pancreatic carcinoma frequently infiltrates the portal vein or the superior mesenteric vein; pancreatectomy combined with portal vein/superior mesenteric vein resection represents a potentially curative treatment in these cases but is still a controversial procedure.
After performing a computerized Medline search, 12 series published during the last 8 years were selected, enrolling 399 patients who underwent pancreatectomy combined with portal vein/superior mesenteric vein resection for pancreatic carcinoma. Data were examined for information about indications, operation, adjuvant therapies, histopathology of resected specimens, perioperative results, and survival. Also, previous literature regarding the issue was extensively reviewed.
Operative mortality and postoperative complication rates ranged from 0 to 7.7% and 16.7% to 54%, respectively. Median survival varied from 13 to 22 months; 5-year survival rate ranged from 9% to 18%.
The current literature suggests that portal vein/superior mesenteric vein resection combined with pancreatectomy is a safe and feasible procedure that increases the number of patients who undergo curative resection and, therefore, provides important survival benefits to selected groups of patients. This procedure should always be considered in case of suspected tumor infiltration of portal/superior mesenteric vein to achieve clear resection margins, in the absence of other contraindications for resection.

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Available from: Valentina Giaccaglia, May 22, 2015
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    • "The most common unexpected finding at the time of pancreaticoduodenectomy in pancreatic carcinoma of the head and uncinate process is the invasion of the superior mesenteric vein (SMV) or superior mesenteric portal vein (SMV/PV) confluence, located anteriorly, laterally, or posterolaterally [3,4]. The current literature suggests that portal vein and/or SMV invasion is not a contraindication to pancreatic resection, provided that these veins are not occluded [5]. In this report, we describe a case of resection of the SMV and restoration of its continuity by inter-position of an autologous superficial femoral vein (SFV) graft, since few data exist about SMV reconstruction with a SFV graft during pancreatectomy. "
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    ABSTRACT: Tumors of the pancreatic head can infiltrate the superior mesenteric vein. In such cases, the deep veins of the lower limbs can serve as suitable autologous conduits for superior mesenteric vein reconstruction after its resection. Few data exist, however, describing the technique and the immediate patency of such reconstruction. We present the case of a 70-year-old Caucasian man with a metachronous metastasis of colon cancer and infiltration of the uncinate pancreatic process, on the anterior surface of which the tumor was located. En bloc resection of the tumor was performed with resection of the superior mesenteric vein and reconstruction. A 10 cm segment of the superficial femoral vein was harvested for the reconstruction. The superficial femoral vein segment was inter-positioned in an end-to-end fashion. The post-operative conduit patency was documented ultrasonographically immediately post-operatively and after a six-month period. The vein donor limb presented subtle signs of post-operative venous hypertension with edema, which was managed with compression stockings and led to significant improvement after six months. In cases of exploratory laparotomies with high clinical suspicion of pancreatic involvement, the potential need for vascular reconstruction dictates the preparation for leg vein harvest in advance. The superficial femoral vein provides a suitable conduit for the reconstruction of the superior mesenteric vein. This report supports the uncomplicated nature of this technique, since few data exist about this type of reconstruction.
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    Full-text · Article · Feb 2009 · Annals of Surgical Oncology
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