Palliative pancreaticoduodenectomy

Abstract

Background: This study was to evaluate the surgical, oncological and survival outcomes after pancreaticoduodenectomy (DP) with superior mesenteric vein (SMV)/ portal vein (PV) resection for borderline resectable periampullary malignancy by either robotic PD (RPD) or open PD (OPD). Methods: Data for periampullary lesions undergoing PD were retrieved from a prospectively-collected computer database. Surgical risks, oncological and survival outcomes were compared between groups with and without SMV/PV resection. Results: A total of 391 patients undergoing pancreaticoduodenectomy were included for analysis, including 43 (11.0%) with and 384 (89.0%) without vein resection. Eleven (25.6%) of PDs with vein resection were performed by robotic approach. Operation time in vein resection group was significantly longer (median of 8 vs. 7 hours). Blood loss, curative resection (R0) rate, and harvested lymph node number were similar between these two groups. Surgical outcomes including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), chyle leakage, wound infection and hospital stay were of no significant different between these two groups. There was no survival difference between these groups, with 1-year and 3-year survival rates of 92.6% and 26.5% respectively for the patients with vein resection, vs. 70.3% and 37.2% without vein resection. Conclusions: PD with vein resection is technically feasible not only by open approach but also by robotic approach in selected patients. Additional SMV/PV would not increase the surgical risks of PD, and moreover, could achieve similar survival outcomes for pancreatic head adenocarcinoma when compared to PD without vein resection.