Proposed Chaoyang vascular classification for superior mesenteric-portal vein invasion, resection, and reconstruction in patients with pancreatic head cancer during pancreaticoduodenectomy – A retrospective cohort study

Abstract

BackgroundPatients with pancreatic head cancer involving the superior mesenteric-portal vein can benefit from vascular resection and reconstruction. We aimed to propose our vascular classification and assess its effect in this study. Material and methodsData of consecutive patients, who were diagnosed with pancreatic head cancer, and underwent radical pancreaticoduodenectomy combined with superior mesenteric-portal vein resection and reconstruction at our institute between October 2013 and August 2016, were retrospectively collected. On a scale of one to four, our classification was proposed. Perioperative parameters were then analyzed among the four types. ResultsThere were a total of 52 patients with 11 in type Ⅰ, 15 in type Ⅱ, 18 in type Ⅲ, 8 in type Ⅳ. The respective operative time and estimated blood loss of types Ⅲ (425–990 min, 265–1820 mL) and Ⅳ (480–1036 min, 330–1690 mL) were greater than those of types Ⅰ (300–824 min, 200–1255 mL) and Ⅱ (369–875 min, 305–1400 mL) (p < 0.05). Type Ⅳ had larger tumors (4–7 cm) than type Ⅰ (1.5–4 cm) (p < 0.05). Percentage of tunica intima involvement and the median survival time of type Ⅰ (9.1%, 22 months) were lower and longer than those of types Ⅱ (46.7%, 17 months) and Ⅲ (44.4%, 16 months; p < 0.05), and even lower and longer than those of type Ⅳ (87.5%, 10 months; p < 0.01), respectively. ConclusionsOur classification can provide a system to grade patients with venous invasion in order of surgical difficulty and survival.