Surgical treatment of pancreatic tumors invading the spleno-mesenteric-portal vessels. An italian multicenter survey

BACKGROUND/AIMS: The authors are interested in determining the diagnostic and surgical approach followed in different Italian institutions in the treatment of adenocarcinoma of the head of the pancreas, whenever the spleno-mesenteric-portal confluence is invaded. METHODOLOGY: A 10-item questionnaire was sent to 21 Italian Centers of Surgical Oncology and a total of 1185 patients treated with pancreaticoduodenectomy were collected from 15 centers. Among them, 164 spleno-mesenteric-portal vein (SMPV) resections were performed. RESULTS: In all collaborative centers, the diagnostic work-up is comparable with what is reported in the literature. An accurate pre- and intra-operative staging and a differential diagnosis between inflammatory and neoplastic involvement of the vessel walls is universally considered essential for its surgical and oncological implications. If vessel involvement is ruled out, 7 centers proceed to pancreasectomy anyway. Direct end-to-end vein reconstruction is used as the primary procedure, but interposition of PTFE and autologous vein grafting may be used. An overall 4.8% post-operative complications only have been reported. Mean perioperative mortality reported is 3.8% (0-11.5%) and morbidity is 22.8% (4.7-57%). Survival rate is 10 months overall, The mean actuarial 5-year survival is 12%. CONCLUSIONS: The attitude of the collaborative centers in cases of SMPV involvement varies, with a slight majority favoring a conservative behavior. Surgical resection extended to the vessels is still uncommon, even in centers mostly experienced in surgery of the pancreas. We believe that vascular resections can be safely performed in both of the different conditions: localized tumors locally invading the vessels and neoplasms with massive invasion of the peripancreatic structures. We share with others the opinion that, in experienced centers, extensive resections should have a role for palliation of carcinoma of the pancreas whenever they offer a better quality of life, although life expectancy may not be positively influenced.