Clinical efficacy of pancreaticoduodenectomy with vein resection via inferior mesenteric vein for tumors in the head and neck of pancreas

Abstract

Objective To investigate the clinical efficacy of pancreaticoduodenectomy with vein resection (PD +VR) via inferior mesenteric vein (IMV) for tumors in the head and neck of pancreas. Methods The clinical data of 62 patients who underwent modified PD +VR for tumors in the head and neck of pancreas at the West China Hospital of Sichuan University between January 2006 to December 2013 were retrospectively analyzed. Twenty-eight patients undergoing Whipple procedure via inferior mesenteric vein were allocated to the WATIMV group, and 34 patients with pancreatic transection as central pancreatectomy undergoing PD +VR were allocated to the c-PD +VR group. The operation time, volume of intraoperative blood loss, rate of patients with intraoperative blood loss >800 mL, rate of intraoperative blood transfusion, length of vein resection, R1 resection rate, site of positive margin, incidence of complications, classification of complications and duration of postoperative hospital stay were compared between the 2 groups. Patients were followed up via outpatient examination and telephone interview till December 2014. Count data of ratio and proportion were compared by the chi-square test. Measurement data with normal distribution were presented as ±s and analyzed by independent sample t test. Results All the 62 patients underwent operation successfully without perioperative death.The operation time, rate of intraoperative blood transfusion, length of vein resection, incidence of complications, incidence of grade 1, 2, 3, 4, 5 complication, duration of postoperative hospital stay were (325 ±50) minutes, 35.7% (10/ 28) , (25 ±5) mm, 46.4%(13/ 28) , 14.3% (4/ 28) , 17.9% (5/ 28) , 14.3% (4/ 28) , 0, 0, (15 ± 7) days in the WATIMV group, and (346 ±97) minutes, 58.8% (20/ 34) , (24 ±5) mm, 50.0% (17/ 34) , 14.7% (5/ 34) , 23.5% (8/ 34) , 8.8%(3/ 34) , 0, 2.9% (1/ 34) , (19 ±11) days in the c-PD +VR group, respectively, showing no significant difference between the 2 groups ( t =0.866, χ2=3.283, t =0.647, χ2 =0.078, 1.883, t =1.666, P >0.05) .The volume of intraoperative blood loss, rate of patients with intraoperative blood loss >800 mL, R1 resection rate, rate of positive margin in pancreas and retroperitoneal positive margin were (534 ±277) mL, 46.4% (13/ 28) , 3.6%(1/ 28) , 0, 3.6% (1/ 28) in the WATIMV group, and (796 ± 567) mL, 67.6% (23/ 34) , 23.5 % (8/ 34) , 8.8% (3/ 34) , 14.7 % (5/ 34) in the c-PD +VR group, respectively, showing significant differences between the 2 groups ( t =2.374, χ2 =2.839, 4.929, 6.507, P <0.05) .Fifty-nine patients were followed up for 15.2 months (range, 8.0-23.0 months) with a follow-up rate of 95.2% (59/ 62) .No patient was complicated with portal vein thrombosis during the follow-up. Conclusion WATIMV is safe and feasible for treatment of tumors in the head and neck of pancreas, helping to improve radical resection rate of carcinoma and operation safety. Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Mesenteric vein resection; Inferior mesenteric vein