Abstracts
1998 Digestive Disease Week
#2319
MAJOR VASCULAR RESECTION AS PART OF PANCREATICO-DUODENECTOMY FOR CANCER: CLINICAL, RADIOLOGIC AND PATHOLOGIC ANALYSIS. RJ Bold, C Charnsangavej, KR Cleary, JE Lee, PWT Pisters, DB Evans. The University of Texas M.D. Anderson Cancer Center, Houston, TX.
INTRODUCTION: Tumor extension to the SMV/portal vein or hepatic artery is a frequent unexpected finding at the time of planned pancreatico-duodenectomy (PD) for malignant tumors of the pancreatic head or periampullary region. In the absence of retroperitoneal tumor extension to involve the SMA or celiac axis, successful vascular resection does not negatively impact survival duration. However, no previous investigator has examined the ability of preoperative imaging to predict the need for vascular resection, or studied the incidence of tumor cell invasion of resected vessels. METHODS: From June 1990 to July 1997, 190 patients underwent PD at a single institution. Technical, radiologic and pathologic data from all patients were entered into a prospective database. In patients who required vascular resection due to direct tumor adherence, the presence or absence of vascular invasion on preoperative contrast-enhanced CT scans was compared to the pathologic assessment of vascular invasion in the specimen. RESULTS: Sixty-nine of the 190 patients underwent resection of the SMV/portal vein (62), inferior vena cava (3), and/or hepatic artery (8). Four patients underwent combined arterial and venous resection and reconstruction. Thirty-day operative mortality was 1.4% (1/69). The type of vascular repair, the presence of tumor extension to vascular structures on preoperative CT and histologic evidence of vascular invasion are shown below:
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TYPE OF REPAIR
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INVASION
ON CT*
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INVASION ON
FINAL PATH**
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primary: 22 (36%)
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34/50 (68%)
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26/43 (61%)
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patch: 9 (14%)
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interposition: 31 (50%)
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primary: 1 (33%)
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2/3 (67%)
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½ (50%)
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patch: 1 (33%)
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interposition: 1 (33%)
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primary 4 (50%)
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5/8 (63%)
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N/A***
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interposition: 4 (50%)
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(Note: *data available on 53 pts; **data available on 45 pts;
***no pathologic examination for arterial invasion performed)
CONCLUSIONS: Invasion of adjacent vascular structures can be predicted on preoperative CT scans in the majority of patients and should alert the surgeon that PD will require vascular resection and reconstruction. Operative mortality is not increased when major vascular resection is an additional component of standard PD. Importantly, histologic evidence of tumor cell infiltration of the SMV/portal vein was present in 61% of specimens.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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