Venous resection in pancreatic oncologic surgery: Different techniques for different situations

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Malignant pancreatic lesions often involve adjacent vasculature, complicating surgical management.
• Vascular resection and reconstruction are critical for achieving complete tumor resection (R0) in select cases.

Purpose of the Study:

• To evaluate the clinical outcomes of patients with malignant pancreatic lesions undergoing oncological surgery with vascular resection.
• To analyze surgical techniques, reconstruction methods, pathological findings, and patient survival.

Main Methods:

• Retrospective analysis of 41 patients with malignant pancreatic lesions and vascular involvement (2013-2021).
• Surgical procedures included pancreaticoduodenectomy (Whipple procedure) and vascular reconstruction (suture, end-to-end, graft).

Main Results:

• Pancreaticoduodenectomy was performed in 85% of patients; 41% had vascular involvement in the resected segment.
• R0 resection was achieved in 83% of cases. Three-year and five-year survival rates were 48% and 20%, respectively.
• No postoperative mortality was observed, with low rates of severe morbidity (Clavien Dindo >3).

Conclusions:

• Aggressive surgical treatment involving venous resection and reconstruction for malignant pancreatic lesions is a viable approach.
• This technique achieves R0 resection with acceptable morbidity, mortality, and overall survival rates.