Surgical treatment of pancreatic tumors invading the spleno-mesenteric-portal vessels. An Italian multicenter survey

BACKGROUND/AIMS: The authors are interested in determining the diagnostic a nd surgical approach followed in different Italian institutions in the trea tment of adenocarcinoma of the head of the pancreas, whenever the spleno-me senteric-portal confluence is invaded. METHODOLOGY: A TO-item questionnaire was sent to 21 Italian Centers of Surg ical Oncology and a total of 1185 patients treated with pancreaticoduodenec tomy were collected from 15 centers. Among them, 164 spleno-mesenteric-port al vein (SMPV) resections were performed. RESULTS: In all collaborative centers, the diagnostic work-up is comparable with what is reported in the literature. An accurate pre- and intra-operat ive staging and a differential diagnosis between inflammatory and neoplasti c involvement of the vessel walls is universally considered essential for i ts surgical and oncological implications. If vessel involvement is ruled ou t, 7 centers proceed to pancreasectomy anyway. Direct end-to-end vein recon struction is used as the primary procedure, but interposition of PTFE and a utologous vein grafting may be used. An overall 4.8% post-operative complic ations only have been reported. Mean perioperative mortality reported is 3. 8% (0-11.5%) and morbidity is 22.8% (4.7-57%). Survival rate is 10 months o verall. The mean actuarial 5-year survival is 12%. CONCLUSIONS: The attitude of the collaborative centers in cases of SMPV inv olvement varies, with a slight majority favoring a conservative behavior. S urgical resection extended to the vessels is still uncommon, even in center s mostly experienced in surgery of the pancreas. We believe that vascular r esections can be safely performed in both of the different conditions: loca lized tumors locally invading the vessels and neoplasms with massive invasi on of the peripancreatic structures. We share with others the opinion that, in experienced centers, extensive resections should have a role for pallia tion of carcinoma of the pancreas whenever they offer a better quality of l ife, although life expectancy may not be positively influenced.