This document summarizes several studies on portal vein resection for pancreatic cancer. It describes Ishikawa's categorization of portal vein invasion based on angiography findings and a retrospective review of 35 patients. It also discusses studies from MD Anderson of 31 patients who underwent portal vein resection, with 72% found to have histologic tumor invasion. Memorial Sloan Kettering studied 42 patients who underwent portal vein resection, with a median survival of 13 months for those patients versus 17 months for patients without portal vein resection. The conclusion is that for selected patients, portal vein invasion may not preclude resection, though blood loss and surgery time are increased, and survival can be similar to those without portal vein invasion.

1. Annals of Surgery 1992;215:231-236
Portal vein resection
• Ishikawa: Categorized the degree of portal
vein invasion based on angiography
• Retrospective review of 35 pts locally
advanced pancreatic CA

2. Annals of Surgery 1992;215:231-235

3. Annals of Surgery 1992;215:231-235

4. British Journal of Surgery 1998;85:611-617
Portal vein resection
• MD Anderson: 31 PVR vs. 44 from 1990-95
• 72% PVR histologic tumor invasion
• Tumors 3.5 cm vs. 3.0
• Margin status and lymph node status similar
• Portal vein reconstruction
– Saphenous vein patch, primary anastomosis,
interposition graft with internal jugular vein or Gore-
Tex
• Internal jugular vein graft – no occlusion

5. British Journal of Surgery 1998;85:611-617

6. Annals of Surgery 1996;224:342-349
Portal vein resection
• Memorial-Sloan Kettering
• 42 pts PVR (17% resections)
• Median survival: 13 mos PVR vs. 17 mos

7. Annals of Surgery 1996;224:342-349

8. Portal vein resection
• Conclusions
1. Portal vein invasion appears to be a matter of
location, not biology.
2. Selected patients with portal vein invasion
can undergo resection.
3. Blood loss and OR time are increased.
4. Survival similar to those patients without
portal vein invasion.