Faculty Collaboration Database

Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg 1999;3(3):233-43

Date

09/11/1999

Pubmed ID

10481116

DOI

10.1016/s1091-255x(99)80065-1

Scopus ID

2-s2.0-0033122779 (requires institutional sign-in at Scopus site)   114 Citations

Abstract

Intraoperative assessment is inaccurate in defining the relationship of a pancreatic head neoplasm to adjacent vascular structures. We evaluated the ability of preoperative contrast-enhanced CT to predict the need for vascular resection during pancreaticoduodenectomy and examined the resected vessels for histologic evidence of tumor invasion. During a 7-year period, 63 patients underwent pancreaticoduodenectomy with en bloc resection of adjacent vascular structures for a presumed pancreatic head malignancy. Clinical, radiologic, operative, and pathologic data were reviewed and analyzed. Fifty-six patients underwent resection of the superior mesenteric-portal vein confluence, three patients required inferior vena cava resection, and the hepatic artery was resected and reconstructed in eight patients. The operative mortality rate was 1.6%, and the overall complication rate was 22%. CT predicted the need for resection of the superior mesenteric or portal veins in 84% of patients. Pathologic analysis revealed tumor invasion of the vein wall in 71% of resected specimens. Tumor invasion of vascular structures adjacent to the pancreas can be predicted with preoperative CT and should alert the surgeon that vascular resection may be required. Histologic evidence of tumor cell infiltration of vessel walls was present in the majority of the resected specimens.

Author List

Bold RJ, Charnsangavej C, Cleary KR, Jennings M, Madray A, Leach SD, Abbruzzese JL, Pisters PW, Lee JE, Evans DB

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Carcinoma, Neuroendocrine
Contrast Media
Female
Forecasting
Hepatic Artery
Humans
Intraoperative Care
Male
Mesenteric Artery, Superior
Mesenteric Veins
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Pancreas
Pancreatic Neoplasms
Pancreaticoduodenectomy
Portal Vein
Radiographic Image Enhancement
Survival Rate
Tomography, X-Ray Computed
Vascular Surgical Procedures
Vena Cava, Inferior