Evidence-Based Medicine
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2014; 20(46): 17448-17455
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17448
Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability
Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo
Tan To Cheung, Ronnie TP Poon, Kenneth SH Chok, Albert CY Chan, Simon HY Tsang, Wing Chiu Dai, See Ching Chan, Sheung Tat Fan, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
Author contributions: Cheung TT, Poon RTP, Fan ST, and Lo CM designed the research; Cheung TT, Poon RTP, Fan ST, Lo CM, Chok KSH, Chan ACY and Chan SC performed the research; Cheung TT, Dai WC and Tsang SHY analyzed the data and wrote the paper.
Correspondence to: Tan To Cheung, FRCS, MBBS, Associate Professor, Department of Surgery, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong, China. tantocheung@hotmail.com
Telephone: +852-2-2553025 Fax: +852-2-8165284
Received: January 27, 2014
Revised: March 13, 2014
Accepted: July 16, 2014
Published online: December 14, 2014
Abstract

AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.

METHODS: Between January 2001 and March 2012, 136 patients received pancreaticoduodenectomy for adenocarcinoma at our hospital. Seventy-eight patients diagnosed with pancreatic head carcinoma were included in this study. Among them, 46 patients received standard pancreaticoduodenectomy (group 1) and 32 patients received pancreaticoduodenectomy with simultaneous resection of the portal vein or the superior mesenteric vein or artery (group 2) followed by reconstruction. The immediate surgical outcomes and survivals were compared between the groups. Fifty-five patients with unresectable adenocarcinoma of the pancreas without liver metastasis who received only bypass operations (group 3) were selected for additional survival comparison.

RESULTS: The median ages of patients were 67 years (range: 37-82 years) in group 1, and 63 years (range: 35-86 years) in group 2. All group 2 patients had resection of the portal vein or the superior mesenteric vein and three patients had resection of the superior mesenteric artery. The pancreatic fistula formation rate was 21.7% (10/46) in group 1 and 15.6% (5/32) in group 2 (P = 0.662). Two hospital deaths (4.3%) occurred in group 1 and one hospital death (3.1%) occurred in group 2 (P = 0.641). The one-year, three-year and five-year overall survival rates in group 1 were 71.1%, 23.6% and 13.5%, respectively. The corresponding rates in group 2 were 70.6%, 33.3% and 22.2% (P = 0.815). The one-year survival rate in group 3 was 13.8%. Pancreaticoduodenectomy with simultaneous vascular resection was safe for pancreatic head adenocarcinoma.

CONCLUSION: The short-term and survival outcomes with simultaneous resection were not compromised when compared with that of standard pancreaticoduodenectomy.

Keywords: Adjuvant therapy, Head of pancreas, Liver transplant, Morbidity, Mortality, Portal vein resection, Survival analysis, Whipple operation

Core tip: Whipple operation with vascular reconstruction is considered one of the most difficult operations with high morbidity. In this paper, we demonstrate that this complicated surgery can be performed in low-volume centers where a high volume of other complicated liver surgeries, including liver transplant, are performed.