The Value Of The Surgery With Vascular Resection And Reconstruction For Pancreatic Cancer

Objective To investigate the value of combined vascular resection and reconstruction in radical resection of pancreatic cancer and the difference with non pancreatic cancer resection in the vascular complications and long-term prognosis.Methods The clinical data of 206 patients with pancreatic cancer who underwent radical resection from January 2009 to March 2014 were retrospectively analyzed.The inclusion criteria:1. Patients with preoperative examinations in general good, no other system of primary malignant tumor;2.no hepatic, mesenteric and distant metastasis before preoperation;3.Intraoperative portal vein and superior mesenteric vein invasion, but can go resection and reconstruction;5. Postoperative pathology confirmed epithelial carcinoma(exclude non epithelial malignant tumor and metastatic carcinoma).A total of 206 patients were included in the study.All cases were divided into non- vascular resection group(group A, 132cases), the combined vein resection group(group B, 66 cases) and the combined arterial resection group(group C, 8 cases). Among all patients, 137 patients underwent pancreaticoduodenectomy(PD), 44 patients underwent distal pancreatectomy(DP), and 25 patients underwent total pancreaticoduodenectomy(TPD). The perioperation data, the incidence of postoperative complications and the survival were compared in pairs among three groups. All patients were followed up till September 2014. P1, P2 and P3 stand for A: B, A: C and B: C.Results There were no statistical differences for the preoperative data among three groups. The operation time and the blood loss were(347±96)minutes and(603±380)ml in group A,(425±91)minutes and(889±629)ml in group B,(508±120)minutes and(1925±1181)ml in group C, with significant differences among three groups(P1<0.01, P2<0.01, P3<0.05). The incidence of postoperative complication was 16.7% in group A, 28.8% in group B, and 75% in group C, respectively. There were significant differences between groups A and B(χ2=3.937, P=0.047), groups A and C(χ2= 12.603, P<0.05), as well as between groups B and C(χ2=4.902, P<0.05). The median survival time was 15 months for group A, 15 months for group B, and 12 months for group C. No significant difference was found among three groups.(P1、P2 and P3>0.05). The postoperative mortality was nil for all of groups.Conclusion Compared with non-vascular resection, combined vein resection can be performed safely with a similar prognosis. Compared with either group A or group B, combined arterial resection and reconstruction increased the operation time and blood loss significantly with higher morbidity. There were more patients with positive resection margin in this group. Therefore, the surgery of combined arterial resection could only be justified when R0 resection for pancreatic cancer could be achieved for highly selected patients.