Should Portal Vein Resection Be Done in Patients with Locally Advanced Pancreas Cancer?

The main factor affecting resection in pancreatic adenocarcinoma is the involvement of the portal vein due to the anatomical location of the pancreas. This study aimed to investigate the effect of portal vein resection on postoperative morbidity and mortality.
Patients diagnosed with pancreatic cancer who underwent pancreaticoduodenectomy and portal vein resection between January 2014 and December 2018 were included in the study retrospectively. Besides, the demographic data of the patients, postoperative morbidity, and mortality rates were documented.
Seventeen patients [mean age 62.4 years; 11 (65%) were male, and 6 (35%) were female] were included in the study. Endoscopic retrograde cholangiopancreatography was applied to 10 patients (58%) with cholangitis at presentation. CA 19-9 elevation was found in all patients, and its mean was found to be 1497 U/L. Total pancreaticoduodenectomy was applied to 2 (11.7%) of 17 patients. In one patient (5.8%), hepatic artery resection, besides portal vein resection, was performed. The mean operation time was 2350 min, while the average blood loss was 820 mL. The most common TNM stage was T2N1M0 with 11 patients (64%). The pancreatic fistula was diagnosed in 3 (20%) of 15 patients. One patient with Grade C fistula died on the 27th postoperative day due to sepsis and multiorgan failure. Postoperative morbidity was encountered in 10 patients (58.8%). The average hospital stay of the patients was 12.4 days.
Portal vein resection increases the pool of patients who benefit from surgery in pancreatic cancer. However, it can be performed safely with morbidity and mortality rates similar to those of conventional pancreatectomies in experienced hands.