Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile?

Background: Whether or not superior mesentericoportal venous resection (SM- PVR) associated with pancreaticoduodenectomy (PD) is safe and worthwhile ha s not been fully confirmed. The aim of the present study was to investigate results of this surgical procedure performed for pancreatic head and peria mpullary neoplasms. Methods: As a first analysis, postoperative morbidity and mortality after P ID with (n = 31) or without SM-PVR (n = 119) were investigated in 150 patie nts with pancreatic head and periampullary neoplasms. As a second analysis, rates of margin-negative resection and survival after SM-PVR (n = 21) and without SM-PVR (n = 66) were compared in 87 patients with pancreatic ductal adenocarcinoma of the pancreatic head. In these patients undergoing SM-PVR (n = 21), survival rate was investigated in patients who did (n = 13) and did not (n = 8) undergo a margin-negative resection. Results: In the first analysis, duration of surgery and volume of blood tra nsfused perioperatively were higher in patients undergoing SM-PVR. However, mortality, morbidity rates, and mean hospital stay did not differ between patients who did undergo SM-PVR (31 patients, 3.2%, 48.4%, and 22.2 days, r espectively) and who did not (119 patients, 2.5%, 47.1%, 25.9 days, respect ively). No postoperative death occurred in the recent part of the present s tudy, since 1994, in patients undergoing SM-PVR, In the second analysis of pancreatic ductal adenocarcinoma, rates of margin-negative resection and 2- year survival did not significantly differ between patients who did and did not undergo SM-PVR (62% and 22%, respectively, versus 73% and 24%). In pat ients undergoing, SM-PVR, survival rate was significantly higher for patien ts undergoing a margin-negative resection (n = 13) than for patients underg oing a macroscopic or microscopic margin-positive resection (n 8, 2-year su rvival = 57.1% versus 0%, P <0.05). Conclusion: PD combined with SM-PVR can be performed safely. This surgical procedure is followed by a promising survival rate and can be recommended i n order to obtain a margin-negative resection; however, candidates for SM-P VR should be carefully selected. (C) 2001 Excerpta Medica, Inc. All rights reserved.