Top

Journal of Gastrointestinal Surgery

Published in:

01-12-2008 | original article

Pancreaticoduodenectomy with Vascular Resection for Local Advanced Pancreatic Head Cancer: A Single Center Retrospective Study

Authors: Chunyou Wang, Heshui Wu, Jiongxin Xiong, Feng Zhou, Jing Tao, Tao Liu, Gang Zhao, Shanmiao Gou

Published in: Journal of Gastrointestinal Surgery | Issue 12/2008

Abstract

Introduction

Pancreaticoduodenectomy with vascular resection remains a controversial approach for patients with local advanced pancreatic head cancer for the lack of evidences of survival and quality of life benefits. The aim of this study was to evaluate whether patients of pancreatic head cancer benefit on quality of life, survival, and treatment cost from pancreaticoduodenectomy with vascular resection compared with palliative therapy.

Materials and Methods

Two hundred fourteen patients of pancreatic head cancer whose pancreatic head could not be dissected free from adjacent vascular were involved in this study. Eighty of these patients underwent pancreaticoduodenectomy with vascular resection, whereas other patients underwent palliative therapy.

Results

Pancreaticoduodenectomy with artery resection offered worse outcomes on almost all aspects of quality of life and survival compared with palliative therapy. Pancreaticoduodenectomy with vein resection offered better 5-year survival compared with palliative therapy, whereas palliative therapy offered better quality of life after surgery.

Conclusion

Pancreaticoduodenectomy with artery resection is nonsensical on treatment of pancreatic head cancer with artery adhesion/invasion. As for patients with vein adhesion/invasion, pancreaticoduodenectomy with vein resection should be performed cautiously. When actual vein invasion is very possible to have taken place, the choice of treatment strategy should be considered carefully by the pancreatic surgeons.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108.PubMed

Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30.PubMedCrossRef

Makowiec F, Post S, Saeger HD, Senninger N, Becker H, Betzler M, et al. Current practice patterns in pancreatic surgery: Results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German advanced surgical treatment study group). J Gastrointest Surg 2005;9:1080–1086. (discussion 1086–1087). doi:10.1016/j.gassur.2005.07.020.PubMedCrossRef

Yeo CJ, Cameron JL. Pancreatic cancer. Curr Probl Surg 1999;36:59–152.PubMed

Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455–465.PubMed

Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of vater. Ann Surg 1935;102:763–779. doi:10.1097/00000658-193510000-00023.PubMedCrossRef

Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–5. (discussion 435–438)doi:10.1097/00000658-199305010-00002.PubMedCrossRef

Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990;211:447–458. doi:10.1097/00000658-199004000-00011.PubMedCrossRef

Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer. A report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the national cancer database. J Am Coll Surg 1999;189:1–7. doi:10.1016/S1072-7515(99)00075-7.PubMedCrossRef

10.

Fortner JG. Regional resection and pancreatic carcinoma. Surgery 1973;73:799–800.PubMed

11.

Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK. The european organization for research and treatment of cancer. Approach to quality of life assessment: Guidelines for developing questionnaire modules. Eortc study group on quality of life. Qual Life Res 1993;2:287–295. doi:10.1007/BF00434800.PubMedCrossRef

12.

Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998;16:139–144.PubMed

13.

Moore GE, Sako Y, Thomas LB. Radical pancreatoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery 1951;30:550–553.PubMed

14.

Al-Haddad M, Martin JK, Nguyen J, Pungpapong S, Raimondo M, Woodward T, et al. Vascular resection and reconstruction for pancreatic malignancy: A single center survival study. J Gastrointest Surg 2007;11:1168–1174. doi:10.1007/s11605-007-0216-x.PubMedCrossRef

15.

Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 2001;182:120–129. doi:10.1016/S0002-9610(01)00686-9.PubMedCrossRef

16.

Carrere N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg 2006;30:1526–1535. doi:10.1007/s00268-005-0784-4.PubMedCrossRef

17.

Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic tumor study group. Ann Surg 1996;223:154–162. doi:10.1097/00000658-199602000-00007.PubMedCrossRef

18.

Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–347. (discussion 347–349). doi:10.1097/00000658-199609000-00010.PubMedCrossRef

19.

Hartel M, Wente MN, Di Sebastiano P, Friess H, Buchler MW. The role of extended resection in pancreatic adenocarcinoma: Is there good evidence-based justification? Pancreatology 2004;4:561–566. doi:10.1159/000082181.PubMedCrossRef

20.

Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, et al. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg 1998;85:611–617. doi:10.1046/j.1365-2168.1998.00641.x.PubMedCrossRef

21.

Reddy SK, Tyler DS, Pappas TN, Clary BM. Extended resection for pancreatic adenocarcinoma. Oncologist 2007;12:654–663. doi:10.1634/theoncologist.12-6-654.PubMedCrossRef

22.

Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: Margin status and survival duration. J Gastrointest Surg 2004;8:935–949. (discussion 949–950)doi:10.1016/j.gassur.2004.09.046.PubMedCrossRef

23.

Ghaneh P, Costello E, Neoptolemos JP. Biology and management of pancreatic cancer. Gut 2007;56:1134–1152. doi:10.1136/gut.2006.103333.PubMedCrossRef

24.

Tempero M, Arnoletti JP, Ben-Josef E, Bhargava P, Casper ES, Kim P, et al. Pancreatic adenocarcinoma. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2007;5:998–1033.PubMed

25.

Nakao A, Harada A, Nonami T, Kaneko T, Inoue S, Takagi H. Clinical significance of portal invasion by pancreatic head carcinoma. Surgery 1995;117:50–55. doi:10.1016/S0039-6060(05)80229-6.PubMedCrossRef

26.

Loyer EM, David CL, Dubrow RA, Evans DB, Charnsangavej C. Vascular involvement in pancreatic adenocarcinoma. Reassessment by thin-section ct. Abdom Imaging 1996;21:202–206. doi:10.1007/s002619900046.PubMedCrossRef

Title: Pancreaticoduodenectomy with Vascular Resection for Local Advanced Pancreatic Head Cancer: A Single Center Retrospective Study
Authors: Chunyou Wang
Heshui Wu
Jiongxin Xiong
Feng Zhou
Jing Tao
Tao Liu
Gang Zhao
Shanmiao Gou
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0621-9

At a glance: The STEP trials

Springer Medicine

Pancreaticoduodenectomy with Vascular Resection for Local Advanced Pancreatic Head Cancer: A Single Center Retrospective Study

Abstract

Introduction

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2008

Pyogenic Complications of Crohn’s Disease, Evaluation, and Management

Surgical Treatment Concepts for Acute Lower Gastrointestinal Bleeding

Response—The Resection of the Azygos Vein—Necessary or Redundant Extension of Transthoracic Esophagectomy

Letter to the Editor—Early ERCP for Gallstone Pancreatitis: For Whom and When?

Factors Related to Anastomotic Dehiscence and Mortality After Terminal Stomal Closure in the Management of Patients with Severe Secondary Peritonitis

Laparoscopic Segment VI Liver Resection using a Left Lateral Decubitus Position: A Personal Modified Technique