Benefit of venous resection for ductal adenocarcinoma of the pancreatic head.

Objective: To find out whether there is any benefit from venous resection during pancreaticoduodenectomy for ductal pancreatic adenocarcinoma.

Design: Retrospective study.

Setting: University Hospital Mannheim/Heidelberg, Germany.

Interventions: 271 patients had resections for ductal adenocarcinoma of the pancreatic head between 1980 and 2001. The outcome of patients who did (n = 68) and who did not (n = 203) have simultaneous resection of major veins (portal vein and/or superior mesenteric vein) were compared.

Main outcome measurement: 5 year survival.

Results: The groups differed significantly regarding stage, perineural infiltration, lymphangiosis carcinomatosa, operating time, blood loss, and blood transfusion. However, there was no difference in perioperative morbidity (27% and 22%), mortality (4% and 3%), and long-term survival (at 5 years 23% and 24%). Subgroup analysis of patients with margins free of tumour (R0 resections) showed that those patients who had venous resections in whom histological examination did not show infiltration of tumour had the most favourable outcome.

Conclusion: There is no reason to exclude patients with suspected venous infiltration from radical pancreaticoduodenectomy including venous resection.