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ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2010, Number 3

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Cir Gen 2010; 32 (3)

Venous resection in pancreatoduodenectomy. Experience at a Latin American Center

Chan C, Domínguez I, Arriola JC, López-Tello A, Castillo T, Franssen CB, Uscanga LF, Campuzano M

Language: Spanish
References: 15
Page: 155-159
PDF size: 202.49 Kb.


ABSTRACT

Objective: To demonstrate the feasibility of venous resection during pancreatoduodenectomy in a Latin American hospital in transition to a high volume medical center.
Setting: Third level health care center, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”.
Design: Retrospective, transversal, comparative study.
Statistical analysis: Chi square, Student’s t or Mann-Whitney’s U test and Kaplan-Meier’s actuarial survival curves.
Patients and method: Two-hundred patients were subjected to pancreatoduodenectomy in the period from the year 2000 to 2008. We compared the cases with venous resection (n = 20) and pancreatoduodenectomy and those with pancreatoduodenectomy without venous resection (n = 180). Analyzed variables were: preoperative comorbidities, symptoms at diagnosis, imaging studies, postoperative complications with bleeding, delay in gastric emptying, high impact pancreatic fistula, radiological interventionist procedures, re-operations, stay in intensive care and intraoperative bleeding. Regarding the histopathological diagnosis, we recorded the tumor lineage, the presence of surgical margins, and the type of resection (R0,1), metastases to lymphatic ganglia, perineural, vascular, and lymphatic invasion.
Results: Type 1 resection was performed in 14 patients (70%), Type 3 en three (15%), Type 4 in two (10%), and Type 5 in one (5%) patient. Type 2 resection was not performed in any case. Transoperative bleeding was significantly higher in the venous resection group (1,749 vs 788 ml, p = 0.0001). No statistically significant difference was observed in the postoperative mortality during the first 30 days between patients subjected to venous resection and the rest of the series (14 vs 8%, p = 0.4). Survival was similar in both groups.
Conclusion: Venous resection during pancreatoduodenectomy is a feasible technique nowadays with and acceptable rate of morbidity and mortality.


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