Should Portal Vein Be Routinely Resected…

Should Portal Vein Be Routinely Resected During Pancreaticoduodenectomy For Adenocarcinoma?

The authors performed a retrospective cohort study using a matched control group to compare 19 patients undergoing pancreaticoduodenectomy with en-bloc portal vein/superior mesenteric vein (PV/SMV) resection without histological evidence of venous involvement with 19 matched patients undergoing standard pancreaticoduodenectomy. All en-bloc PV/SMV resections included were performed for suspected intra-operative venous invasion but later found to be histologically negative. There was no difference in the immediate postoperative course of the patients between groups with regard to morbidity, mortality, reoperation rate and length of hospital stay. Median survival (42 months vs. 22 months, P=0.02) and overall 3-year survival (60% vs. 31%, P=0.03) were significantly longer in the en-bloc PV/SMV group compared with the control group. The authors discuss that this may relate to a loco-regional clearance effect, however given the retrospective cohort design and relatively small patient sample size selection bias and confounding cannot be excluded. The authors plan to analyse frozen sections of resection margins of the PV bed in patients undergoing standard pancreaticoduodenectomy for evidence of K-ras or other mutations, which may support a randomized controlled trial of routine PV/SMV resection during pancreaticoduodenectomy for resectable pancreatic adenocarcinoma.

Annals of Surgery 2012;doi: 10.1097/SLA.0b013e318269d23c

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