Pancreaticoduodenectomy Combined With Vascular Resection And Reconstruction For Pancreatic Head Carcinoma

ObjectiveThe aim of this study was to evaluate whether patients of pancreatic head cancer benefit on quality of life and survival from pancreaticod uodenectomy with vascular resection and reconstruction. To investigate the significance and the prognostic factors of pancreaticoduodenectomy with vascular resection and reconstruction.MethodsWe collected and retrospectively analyzed the clinical data of 310 patients of pancreatic head cancer which were treated by surgical operation from General Surgery of The Southwest Hospital form January 2008 to December 2013. Including 83 patients treated with PD combined with vascular resection and reconstruction and 45 patients treated with palliative therapy. Descriptive statistics were used to analyze the data including gender, age, initial symptoms, operative time, pathological type, lymph node metastasis and so forth. The information of patients about all-cause death and the exact death time were surveyed by telephone follow- up after three years of the operation. Two independent samples test was used to analyze the measurement data, And the count data were analyzed using the chi-square test. The survival curve wa s drawn by the Kaplan-Meier method, and the survival was analyzed using the Log- rang test, and then Multivariate analysis between the relevant factors were performed through the COX model.ResultsThe median survival time of the 182 cases that received PD was 21.2 months, The postoperative complication incidence was 31.9%, and the mortality rate was 3.8%.The median survival time of the 83 cases that received PD combined with vascular resection was 11.9 months, The postoperative complication incidence was 39.8%, and the mortality rate was 6.0%.The median survival time of the 45 cases that received palliative therapy was 7.3 months, The postoperative complication incidence was 8.9%, and the mortality rate was 0.The median survival time of the 38 cases actual vein invasion was 8.0 months, The postoperative complication incidence was 44.7%, and the mortality rate was 7.9%.The degree of tumor differentiation and the occurrence of complications after surgery were independent prognostic factors that determined the patients’ long- term survival.ConclusionAlthough PD combined with vascular resection and reconstruction increased the incidence of postoperative complications compared with PD without vascular resection, PD combined with vascular resection and reconstruct ion could achieve the complete removal of tumors without significantly increasing the mortality rate. Although the median survival time was higher than that of patients who underwent palliative treatment. But the median survival time of the actual vein invasion group was not better than that of patients who underwent palliative treatment. PD combined with vascular resection surgery has Uncertain clinical significance, so the choice of treatment strategy should be considered carefully by the pancreatic surgeons. In addition, the two independent factors affecting the postoperative survival time were the degree of tumor differentiation and the presence or absence of postoperative complications.