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Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection Cover

Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection

Radiology and Oncology
Volume 50 (2016): Issue 3 (September 2016)
By: Vojko Flis,  Stojan Potrc,  Nina Kobilica and  Arpad Ivanecz  
Free to read
|Jul 2016

Figures & Tables

Figure 1

In presented series basically two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SMV) or portal vein (PV) such that the splenic vein (SplV) could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed (V1). In the remaining cases interposition graft (IG) was needed (V2).
In presented series basically two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SMV) or portal vein (PV) such that the splenic vein (SplV) could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed (V1). In the remaining cases interposition graft (IG) was needed (V2).

Figure 2

Kaplan-Meier survival plot for patients with vein reconstruction (pacreaticoduodenectomy [PD]+ vein resection [VR]). Median survival time in months was in this group 16.1 months.
Kaplan-Meier survival plot for patients with vein reconstruction (pacreaticoduodenectomy [PD]+ vein resection [VR]). Median survival time in months was in this group 16.1 months.

Figure 3

Comparison of Kaplan-Meier survival plots for both groups. Median survival time in months was in group with vein resection (pacreaticoduodenectomy [PD]+ vein resection [VR]) 16.1 months (line B) and in group without vein resection (PD - VR) 15.2 months (line A). Five year survival in group without vein resection (line B) was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090 (z = 1.659 at 5% C; C = 1.96).
Comparison of Kaplan-Meier survival plots for both groups. Median survival time in months was in group with vein resection (pacreaticoduodenectomy [PD]+ vein resection [VR]) 16.1 months (line B) and in group without vein resection (PD - VR) 15.2 months (line A). Five year survival in group without vein resection (line B) was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090 (z = 1.659 at 5% C; C = 1.96).

TNM stage in 111 patients who underwent pancreaticoduodenectomy without vein resection in comparison with vein resection (VR) group_ There is no statistically important difference in N0 and N1 stage between both groups (P = 0_432, Fischer’s exact test, no statistical significance)_

TNM stageWithout VR (n = 111)With VR (n = 22)
T000
T1100
T2260
T37522
T400
N0324
N17918

Resection margins of extirpated tumors_ There is no statistically important difference bewteen both groups (with or without venous resection [VR]) (Chi-square 2_79, p = 0_247)

Resection marginWithout VR (n = 111)With VR (n = 22)
R010218
R0,153
R141

Selected clinical characteristics and preoperative data in patients undergoing pancreaticoduodenectomy with or without vein resection (VR)_ There is no statistically important differences between both groups

VariableWithout VR (n = 111)With VR (n = 22)P-value test
Demographics
Age (average years)65.6 ± 7.763.95 ± 9.5P = 0.45; t test
Sex (male:female)53:589:13P = 0.64; Chi square
ASA score
1347
26112
3162
400P = 0.83; Chi square
Bilirubin level
Below 100mmol/l7718
Above 100mmol/l344P = 0.306; Chi square
CEA (ng/l)
Increased (> 5ng/l)305P = 0.795; Chi square
CA 19-9 (IU/l)
Increased (> 30IU/l)7816P = 1.0; Chi square

List of surgical complications developed after pancreatoduodenectomy_ Comparison between group without vein resection (PD [pacreaticoduodenectomy] - VR [vein resection]) and group with vein resection (PD + VR)

Type of surgical complicationWithout VR (n = 111)With VR (n = 22)
Pancreatic fistula5 (4.5%)1 (4.5%)
Bile leak3 (2.7%)1 (4.5%)
Intraperitoneal bleeding6 (5.4%)0
Abdominal abscess5 (4.5%)0
Gastric emptying syndrome1 (0.9%)1 (4.5%)
Rupture of the laparatomy4 (3.6%)0
Necrosing pancreatitis1 (0.9%)0
Ileus of Roux-Y1 (0.9%)0
Critical ischemia of the colon1 (0.9%)0
Poral vein thrombosis01 (4.5%)
60 day mortality5 (4.5%)1 (4.5%)

Cause of intrahospital deaths between both groups_ (P = 1_0, Fischer’s exact test, no statistical significance in death rate)

Cause of deathWithout VRWith VR
Massive pulmonary embolia10
Cerebrovascular insult10
Myocardial infarction21
Bronchopneumonia10
DOI: https://doi.org/10.1515/raon-2015-0017 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 321 - 328
Submitted on: Dec 17, 2014
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Accepted on: Mar 26, 2015
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Published on: Jul 19, 2016
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
pancreaticoduodenectomy,
pancreatic cancer,
vein resection
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2016 Vojko Flis, Stojan Potrc, Nina Kobilica, Arpad Ivanecz, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons License.

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