Combined resection of the portal vein for pancreatic cancer: Preoperative diagnosis of invasion by portography and prognosis

Background/Aims: Pancreatic cancer often invades the portal vein because of the anatomical position. Pancreatic cancer with portal vein invasion was n ot considered operable, and thus the resectability rate was low. Methodology: Between March 1976 and February 1994, 140 of 243 patients unde rwent resection, a resectability rate of 58%. A total of 81 (58%) of these patients underwent portal vein resection. We assessed 56 patients in whom t he depth of invasion had already been determined histopathologically and wh ose superior mesenteric arterial portograms were readable. The 56 patients were classified into 4 groups: normal (Type I), stricture o n one side of the portal vein (Type II), stricture on both sides of the por tal vein (Type III), complete obstruction (Type IV). The length of the long itudinal lesions on portograms was also measured. Results: In 93% (27/29 cases) of portographic Type I or II lesions with lon gitudinal lesions of 2cm or less, portal vein invasion was limited to the t unica media. No patients with cancer invasion into the lumen survived more than 1 year. Conclusions: For patients with pancreatic cancer Type I or II, preoperative portography findings and longitudinal lesions of 2cm or less, portal vein resection is indicated, and long-term survival can be expected.