Combined Major Vein Resection in Surgery for Biliary-Pancreatic Cancer

Heo, Seung Chul; Kim, Sun Whe; Kim, Ki Hwan; Suh, Kyung Suk; Lee, Kuhn Uk; Park, Yong Hyun

Abstract

Biliary-pancreatic cancers are frequently associated with vascular invasion, as well as adjacent organ invasion, due to their biologic and anatomical characteristics. These findings preclude the curative resection of these tumors due to the high mortality and morbidity following a combined vascular resection. The object of this study was to assess the safety and the effect on survival of the combined vascular resection for patients with biliary-pancreatic malignancies through an analysis of our experience. Fifteen biliary-pancreatic cancer patients underwent curative surgery, including major vascular resection, during the period from Mar. 1993 to Oct. 1996. The risk factors such as the operative mortality, the morbidity, operative time, demand for transfusion, postoperative hospital stay, and the pathological characteristics for the 12 patients who underwent pancreaticoduodenectomy(PD) with combined vascular resection were compared with those of 75 cases who underwent a PD without vascular resection from 1993 to 1995. After resections and reconstructions of superior mesenteric and portal veins, vascular patencies were mostly well preserved, and there were no damage to the liver function. Combined vascular resection did not increase the mortality, the morbidity, the hospital stay, or the operative risk. With respect to pathologic characteristics, tumors with vascular invasion did not have more metastases to the lymph node, but did have more frequent perineural invasions and were slightly larger in size. Vascular invasion alone is not a contraindication to curative resection of biliary-pancreatic cancers and combined vascular-superior mesenteric and portal vein-resection should be considered in selected cases in which histologically curative resection is possible.