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[Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion].

Abstract

AIM

To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer.

MATERIAL AND METHODS

Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection.

RESULTS

Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02).

CONCLUSION

Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.

Authors+Show Affiliations

Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia.

Pub Type(s)

Journal Article

Language

rus

PubMed ID

30560841

Citation

Kriger, A G., et al. "[Diagnosis and Treatment of Pancreatic Head Cancer Followed By Mesenteric-portal Vein Invasion]." Khirurgiia, 2018, pp. 21-29.
Kriger AG, Karmazanovsky GG, Smirnov AV, et al. [Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. Khirurgiia (Mosk). 2018.
Kriger, A. G., Karmazanovsky, G. G., Smirnov, A. V., Kharazov, A. F., Gorin, D. S., Raevskaya, M. B., Galkin, G. V., & Revishvili, A. S. (2018). [Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. Khirurgiia, (12), 21-29. https://doi.org/10.17116/hirurgia201812121
Kriger AG, et al. [Diagnosis and Treatment of Pancreatic Head Cancer Followed By Mesenteric-portal Vein Invasion]. Khirurgiia (Mosk). 2018;(12)21-29. PubMed PMID: 30560841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. AU - Kriger,A G, AU - Karmazanovsky,G G, AU - Smirnov,A V, AU - Kharazov,A F, AU - Gorin,D S, AU - Raevskaya,M B, AU - Galkin,G V, AU - Revishvili,A Sh, PY - 2018/12/19/entrez PY - 2018/12/19/pubmed PY - 2019/5/28/medline KW - borderline resectable tumor KW - pancreatic cancer KW - pancreaticoduodenectomy KW - vein invasion KW - vein resection SP - 21 EP - 29 JF - Khirurgiia JO - Khirurgiia (Mosk) IS - 12 N2 - AIM: To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer. MATERIAL AND METHODS: Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection. RESULTS: Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02). CONCLUSION: Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases. SN - 0023-1207 UR - https://www.unboundmedicine.com/medline/citation/30560841/[Diagnosis_and_treatment_of_pancreatic_head_cancer_followed_by_mesenteric_portal_vein_invasion]_ L2 - https://doi.org/10.17116/hirurgia201812121 DB - PRIME DP - Unbound Medicine ER -