Long term results of pancreatectomy with portal-superior mesenteric vein resection for pancreatic carcinoma: a systematic review.

ABSTRACT

BACKGROUND/AIMS: Clinical benefit from pancreatectomy combined with portal vein/superior mesenteric resection in the pancreatic carcinoma with local venous invasion still remains controversial. The aim of this study was to review the overall outcome of the pancreatectomy combined with portal vein/superior mesenteric resection for pancreatic carcinoma with local venous invasion. METHODOLOGY: A systematic literature search (Medline, Embase, Cochrane Library, Biosis, Science Citation Index, Ovid Journals) was performed to identify all eligible articles from January 2000 to December 2009. The methodological quality of included studies on portal vein/superior mesenteric resection during pancreatectomy for pancreatic carcinoma was evaluated independently by 2 authors and 47 non-duplicated studies providing relevant data was found. Quantitative data on operation, perioperative results (blood loss, operative time, and length of hospital stay), mortality, morbidity, histopathology of resected specimens, adjuvant therapies, and overall outcome were extracted from included studies for systematic analysis. RESULTS: The median operating time was 480 (140-1340) min, blood loss 1420 (50-14280) ml and the length of hospital stay 16 (4-123) days. Operative mortality and postoperative morbidity rates ranged from 0 to 14.3 % and 6 % to 67 % with a median of 3.5 % and 33 %, respectively. Median survival was 15 months and ranged from 1.6 to 250 months, and 1-, 2-, 3- and 5-year survival rates ranged from 28.5 to 92, 6.7 to 81.1, 0 to 60.3 and 0 to 24 % with a media of 56.6, 31.5, 17 and 12 %, respectively. Specimen histopathology confirmed venous invasion, perineural invasion and lymphnodal involvement in 66.6,53 and 73%, respectively. CONCLUSIONS: In properly selected patients, pancreatectomy combined with portal vein/superior mesenteric resection is a feasible surgical procedure with a survival benefit for pancreatic carcinoma, and the systemic chemotherapy is indispensable as the common events of perineural invasion and lymphnodal involvement of the pancreatic carcinoma with local venous invasion.