INTRAOPERATIVE CYTODIAGNOSIS FOR DETECTING A MINUTE INVASION OF THE PORTAL-VEIN DURING PANCREATICODUODENECTOMY FOR ADENOCARCINOMA OF THE PANCREATIC HEAD

During pancreatoduoclenectomy for adenocarcinoma of the pancreatic hea d, we frequently encountered cases in which the superior mesenteric-po rtal venous confluence (SMPVC) was involved with cancer. With regard t o the indication of the concomitant SMPVC resection, as suggested by r ecent papers, a better long-term outcome would be expected if the canc er invasions were limited to the tunica adventitia or media of the SMP VC wall. Since this raised fears whether such a small SMPVC invasion w as always detectable by macroscopic inspection alone, we have performe d an intraoperative cytology on the touch smear of the exposed SMPVC w all for 23 patients with pancreatic head cancer. All of their SMPVCs w ere separated from the pancreatic head and appeared to be intact at a macroscopic level, As a result of the cytologic examination, however, 7 patients (30%) were newly diagnosed as having cancer cells on the SM PVC wall, and they received an additional resection of the SMPVC. Post operative histology indicated that cancer invasion into the SMPVC wall was present in 6 of the 7 patients, and that the cancer invasions wer e limited in the tunica adventitia in 5 patients and to the tunica med ia in 1 patient. Thus, in order not to miss the chance of cure by SMPV C resection, our intraoperative cytology on the touch smear of the SMP VC is worth performing more actively on the macroscopically intact-loo king SMPVC during resection of pancreatic cancer. Am J Surg. 1998;175: 477-481, (C) 1998 by Excerpta Medica, Inc.