Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy

Background. Resection of the portal/superior mesenteric vein (PV/SMV) durin g pancreatoduodenectomy (PD) is disputed. Although morbidity and mortality are acceptable, survival is limited after PV/SMV resection. IN this study, we evaluate the effect of PV/SMV resection. Methods. Between 1992 and 1998, there were 215 consecutive patients who und erwent PD for malignant disease. Thirty-four patients underwent a PV/SMV re section. Resection was only performed when minimal venous ingrowth was foun d perioperatively. Surgical techniques, perioperative parameters, and survi val were analyzed. Results. The percentage of PV/SMV resections was 16%. Extensive (segment) r esections were performed in 6 patients. The median blood loss was 1.8 L and resection margins were microscopically tumor free in 41% of the patients. The median hospital sta was 15 days, and mortality was 0%. Median survival after PV/SMV resection for pancreatic adenocarcinoma was 14 months. Conclusions. Limited PV/SMV resection for perioperatively encountered minim al venous ingrowth during PD can be performed safely without increased morb idity and mortality but also results in a high frequency of tumor-positive resection margins.