Clinical value of surgical treatment for pancreatic carcinoma with portal venous system invasion / 中华胰腺病杂志

ABSTRACT

Objective:To analyze the value and significance of surgical operation in the treatment of pancreatic carcinoma with portal venous system invasion.Methods:The clinical data of 66 patients of pancreatic carcinoma with portal venous system invasion admitted in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2018 were retrospectively analyzed. Vascular resection and reconstruction was used on all patients who underwent radical resection for pancreatic carcinoma (portal vein system invasion group). The operation procedure was made according to the location of the pancreatic carcinoma, and the vascular reconstruction procedure was made according to the type and location of portal venous system invasion. The intraoperative and perioperative situation of the patients were analyzed. Then 129 patients of pancreatic carcinoma without portal venous system invasion in the same period were selected as the control group, and the long-term prognosis between the two groups was compared.Results:The operation was successfully in 66 patients. According to the location of the pancreatic carcinoma, 55 patients underwent pancreatoduodenectomy, 8 patients underwent total pancreatoduodenectomy and 3 patients underwent distal pancreatectomy. According to the type and location of portal venous system invasion, 43 patients underwent allogeneic vascular replacement, 16 patients underwent segmental resection with end-to-end anastomosis, and 7 patients underwent wedge resection with primary closure. There was no perioperative death in this group. The incidence of postoperative complications was 28.8%(19/66), and the incidence of biochemical fistula was 9.1%(6/66), intraperitoneal infection was 7.6%(5/66), intraperitoneal hemorrhage was 4.5%(3/66), delayed gastric emptying was 4.5%(3/66), pancreatic fistula of Grade C was 1.5%(1/66) and biliary fistula was 1.5%(1/66). All the patients were discharged successfully, and the postoperative hospital stay was (20.8±9.7) days. 65 patients were followed up, and the follow-up rate was 98.5%. The median survival time of portal venous system invasion group and control group was 13 months and 22 months, respectively. The overall 1-year, 2-year and 3-year survival rates of portal venous system invasion group and control group were 53.3%, 30.4%, 23.4% and 73.1%, 45.8% and 40.1%, respectively ( P=0.006). Conclusions:Prognosis of pancreatic carcinoma patients with portal venous system invasion was poor, but it was safe and feasible to perform surgery for such patients. During the operation, different ways of venous reconstruction can be used according to the specific situation of venous invasion.