Optimal Surgical Approach for Peri-Portal Vein Pancreatic Body Cancer: From the Pancreatic Tail or Head Side?

For peri-portal vein (PV) pancreatic body (Pb) cancer, we have often encountered difficulties in selecting the appropriate surgical approach-whether from the pancreatic tail side or the head side. This study aimed to clarify which procedure is more suitable for peri-PV Pb cancer.

We reviewed 30 cases of peri-PV Pb cancer. The resected status of lymph nodes, their positivity rates in each procedure, and postoperative recurrence patterns were analyzed.

Among the 30 patients, 26 underwent distal pancreatectomy (DP), 3 underwent pancreatoduodenectomy, and 1 underwent total pancreatectomy. In the DP group, the gastroduodenal artery (GDA) was dissected to secure resection margins in 4 cases. The pancreatic transection lines were as follows: 1 to the right of the GDA, 3 at the GDA, 8 to the left of the GDA, and 14 to the right of the PV. Pathologic findings revealed the highest rate of lymph node metastasis in the splenic lymph nodes (#11, 32.1%), followed by the common hepatic lymph nodes (#8, 30.0%) and subpancreatic lymph nodes (#18, 18.5%). Only 1 case involved metastasis outside the regional Pb nodes-posterior pancreatic head (#13)-in a patient with suspected preoperative GDA invasion. Postoperative recurrence analysis showed no critical lymph node recurrence in nodes not resected during the initial procedure.

This study suggests that DP may be an optimal option for peri-PV pancreatic body cancer without invasion of the pancreatic head region.