Resection of the Superior Mesenteric-Portal Vein Confluence During Pancreaticoduodenectomy

Abstract

The current management of patients with pancreatic cancer at our institution involves: (1) a selective approach to the use of laparotomy based on accurate preoperative radiographic imaging techniques and the availability of reliable minimally invasive techniques for biliary decompression, (2) the use of multimodality therapy in all patients with localized, potentially resectable disease, and (3) a standardized approach to surgery and perioperative patient management. The goals of this approach are to maximize length and quality of patient survival while minimizing treatment-related toxicity and limiting the social and economic impact of complicated, multimodality therapy. This chapter focuses on our technique for resection and reconstruction of the superior mesenteric-portal vein (SMPV) confluence at the time of pancreaticoduodenectomy. Our data suggest that tumors invading the SMPV confluence are not associated with histologic parameters suggesting a poor prognosis, and patients who undergo venous resection have a survival similar to patients who undergo standard pancreaticoduodenectomy. Tumor invasion of the SMPV confluence is a function of tumor location rather than an indicator of aggressive tumor biology.