The importance of invasion and resection of superior mesenteric and portal veins in adenocarcinoma of the pancreas.

ABSTRACT

BACKGROUND/AIMS: To achieve a negative surgical margin, resection of superior mesenteric/portal vein is necessary in pancreatic cancer. This study is designed to demonstrate the demographic and clinical differences of the patients requiring major vein resection and the incidence of histopathological vein invasion. METHODOLOGY: A retrospective analysis of patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas between January 2000 and September 2011 was performed. Macroscopic adhesion to vein was considered as an invasion and a resection was performed. RESULTS: Twenty three of 100 patients that underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas had vein resection. Although the operation time (p=0.001), blood loss (p<0.001) and perioperative blood transfusion (p<0.001) were higher in the vein resection group, there were no differences in perioperative and hospital mortality, complication rate and hospitalization time. The tumor was larger (p=0.001) and lymphovascular invasion (p=0.030), perineural invasion (p=0.011), median metastatic lymph nodes (p=0.007), rate of R1 resection (p=0.007) were higher in vein resection group. Only 9 patients out of 23 patients had histopathological vein wall invasion. Overall survival was also not significantly different (p=0.14). CONCLUSIONS: Overall survival in vein resected group was also not significantly different than patients with standard pancreaticoduodenectomy and not all macroscopic vein adhesion means histopathological vein wall invasion.