Survival analysis of pancreaticoduodectomy with vascular reconstruction

Abstract

Introduction: Pancreatic carcinoma and periamullary adenocarcinoma with invasion to portalvein(PV)or superiormesentericvein(SMV) or superiormesentericartery(SMA) are not uncommon. It this study, we aim to analyze the outcome and survival of pacreaticoduodenectomy with en bloc vascular resection.

Material and Methods: Between January 2011 and December 2011, 146 patients received pancreaticoduodenectomy for adenocarcinoma in Department of surgery, Queen Mary Hospital, the University of Hong Kong. 101 patients received standard pancreaticoduodenectomy (group 1) and 35 patients received pancreaticoduodenectomy with en bloc resection of PV/SMV/SMA (group 2) and reconstruction. The immediate surgical outcome and survival were compared. The outcome of another 56 patients with borderline resectable Ca pancreas who received bypass surgery alone (group 3) was compared.

Results: The median blood loss was 800ml (range 170ml-2500ml) in group 1 vs 1250ml (range100ml-5000ml) in group 2(p=0.0005).The median operation time was 570 minutes (range 380 to 917 minutes) in group1 vs 710 minutes (range 449 to 992 minutes)in group2 (p<0.0001).The 1 year,3 yearand fiver year overallsurvival forgroup1 patients was 77.8%,48.2% and 33%. The 1 year, 3 year and fiver year overall survival for group 2 patients was 69.4%,35.8% and 23.9%.(p=0.161). Ingroup 3, the 1 year and 3 year survival was 11.1% and 0%. (p< 0.0001)

Conclusions: Pancreaticoduodenectomy with en bloc vascular resection is a safe treatment for locally advanced adenocarcinoma of the pancreas and periampullary region. It offers patients a better chance of survival compared to palliative bypass procedure.