A Clinicopathological Study of Pancreatoduodenectomy with Combined Resection of Portal Vein in Pancreatic Head Cancer

Kohji Konishi, Masahiko Tsuji, Seiichi Yamamoto, Fumio Futagami, Koichiro Tsugawa, Kiichi Maeda, Kazuhisa Yabushita, Yoshitaka Kuroda, Hiroshi Demachi*, Atsuo Miwa**

Department of Surgery, Department of Radiology*, Department of Clinical Pathology**, Toyama Prefectural Central Hospital

Ninety-four patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy from January 1981 to December 1992, and among them, 40 patients underwent combined resection of the portal vein. This retrospective study attempted to evaluate portal vein resection in pancreatic head cancer by clinicopathological study. Macroscopic portal invasion did not always correspond with microscopic cancerous invasion to the portal vein. No cancerous invasion of the adventitia of the portal vein was shown histologically in 7 of 40 patients (l7.5%). There was no relationship between the degree of histological cancer invasion into the portal vein and staging determinants such as tumor size (t), lymph node metastasis (n), serosal invasion (s), retroperitoneal invasion (rp), peritoneal dissemination (P) and liver metastasis (H). There was no relationship between the degree of portal vein invasion and lymph vessel invasion (ly) or venous invasion (v). The degree of portal vein invasion was not correlated with postoperative survival curves. The longest surviving patient who underwent extended radical pancreatoduodenectomy with combined portal vein resection is still alive after 10 years. Thus, although pancreatic head cancer is often considered unresectable because of portal vein invasion during surgery, we must aggresively attempt to resect the portal vein without abandoning hope.

Key words
pancreatic head cancer, portal vein invasion of pancreatic head cancer, pancreatoduodenectomy, portal vein resection

Reprint requests
Kohji Konishi Department of Surgery, Toyama Prefectural Central Hospital
2-2-78 Nishinagae, Toyama, 930 JAPAN

Accepted
February 9, 1994

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