Pancreatectomies with vein resection: Two large institutions' experience of East and West.
Atsushi Oba, Kimitaka Tanaka, Yosuke Inoue, Roberto Valente, Elena Rangelova, Urban Arnelo, Yoshihiro Ono, Takafumi Sato, Robert J Torphy, Hiromichi Ito, Matthias L��hr, Yu Takahashi, Richard D Schulick, Akio Saiura, Ernesto Sparrelid, Marco Del Chiaro
Author Information
Atsushi Oba: Division of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: atsushi.oba@jfcr.or.jp.
Kimitaka Tanaka: Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Yosuke Inoue: Division of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Roberto Valente: Department of Surgical and Perioperative Sciences, Surgery, Ume�� University, Ume��, Sweden.
Elena Rangelova: Department of Upper Abdominal Surgery at Sahlgrenska University Hospital, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Urban Arnelo: Department of Surgical and Perioperative Sciences, Surgery, Ume�� University, Ume��, Sweden.
Yoshihiro Ono: Division of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Takafumi Sato: Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Robert J Torphy: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Hiromichi Ito: Division of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Matthias L��hr: Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Yu Takahashi: Division of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Richard D Schulick: Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Akio Saiura: Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Ernesto Sparrelid: Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Electronic address: ernesto.sparrelid@regionstockholm.se.
Marco Del Chiaro: Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: marco.delchiaro@cuanschutz.edu.
BACKGROUND: The effectiveness and preferred reconstruction methods of pancreatectomy associated with vein resection (PAVR) for pancreatic Cancer, especially for the extensive portal vein/superior mesenteric vein (PV/SMV) resections (more than 4 cm), are still subjects of debate. The aim of this study is to evaluate the safety and feasibility of PAVR by analyzing data from two large institutions from different regions. METHODS: From 2008 to 2018, we identified consecutive series of patients with pancreatic Cancer who underwent PAVR at Karolinska University Hospital (KUH), Sweden, and Cancer Institute Hospital, Japanese Foundation of Cancer Research (JFCR), Japan. Both institutions adopted the artery-first approach to enhance surgical precision. This study compared the short- and long-term outcomes, vein resection types, and reconstruction methods between the two centers. RESULTS: A total of 506 patients who underwent PAVR were identified, 211 patients were from KUH and 295 patients were from JFCR. A higher incidence of total pancreatectomy was identified at KUH (24.6 % vs 0.3 %). There were no significant differences in intraoperative estimated blood loss (KUH: 630 ml, JFCR: 600 ml), severe complications rate (8.5 %, 5.1 %), and mortality (2.4 %, 0.7 %). Primary end-to-end anastomosis was primarily performed even if the length of PV/SMV resection was 5 cm or more and achieved successfully with acceptable patency (No thrombus rate: overall cases, 98.0 %; 5 cm or more, 93.5 %). CONCLUSIONS: We report favorable outcomes of PAVR for pancreatic Cancer from two high-volume centers in the east and west. Primary end-to-end anastomosis was safe and feasible even if the length of PV/SMV resection was 5 cm or more.
