Cic edizioni internazionali
Il Giornale di Chirurgia

La resezione del confluente venoso mesenterico portale nella chirurgia del carcinoma pancreatico

Articolo, 189 - 192
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Abstract
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Aim: The aim of the present study was to determine the outcome of patients undergoing pancreatic resection en-bloc with mesenteric-portal vein resection for locally advanced pancreatic carcinoma.
Methods: Between January 1986 and December 2007, 223 patients with pancreatic cancer underwent pancreatic resection: in 46 patients, surgery included venous resection for macroscopic invasion of mesenteric-portal vein axis. Survival curves of patients with or without portal vein resection were constructed with Kaplan-Meier method and compared with Log-rank test. Univariate and multivariate analysis were used to analyze the impact of clinicopathologic factors on longterm survival of both groups of patients.
Results: Morbidity and mortality did not differ between the two groups (VR+: 26% and 4.3%; VR-: 30% and 3.9%, respectively). A radical resection was achieved in 36/46 (78%) in the VR+ group and in 123/177 (69%) in the VR- group. Vascular invasion was histologically proven in 26/46 (57%) of the VR+ group. Survival curves were not statistically different between the two groups (p=0.52). In the VR+group only histologically proven vascular invasion significantly impacted survival (p=0.03), while in the VR- group, only R0 resection
(p=0.001) significantly influenced long-term survival.
Conclusion: Vascular resection during pancreatectomy can be performed safely, with acceptable morbidity and mortality. Long-term survival was the same, with or without venous resection. Survival was worse for patients with histologically confirmed vascular infiltration. Since vascular invasion is clearly shown only after histological examination, combined vascular resection with pancreatectomy is justified, whenever possible.

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