Clinical significance of portal invasion by pancreatic head carcinoma

Significance of the Depth of Portal Vein Wall Invasion After Curative Resection for Pancreatic Adenocarcinoma

“…Preoperative celiomesenteric angiography was performed in 83 patients in whom vascular invasion was suspected on the basis of computed tomographic and magnetic resonance imaging findings. The angiographic type on the portogram was determined according to the classification by Nakao et al 13 and is summarized in Figure 1. Carcinoembryonic antigen and carbohydrate antigen 19-9 tumor markers were available in 108 and 103 patients, respectively, and adjusted as recently reported by Schlieman et al 17 Operative procedures included 101 pancreaticoduodenectomies and 20 total pancreatectomies.…”

“…[13][14][15][16] However, it is still unclear whether curative pancreatic resection with PV resection will offer a better chance of longterm survival for patients with PV wall invasion. In fact, reports included some bias because they considered together various types of primary tumor and/or included curative and noncurative resections.…”

“…[19][20][21][22][23][24][25][26][27][28][29][30][31] With regard to the depth of PV wall invasion, several investigators demonstrated that PV wall invasion itself was a negative prognostic factor. 1,[13][14][15][16]18 However, only a few reports have described in detail the correlation between the depth of PV wall invasion and survival. 13,14 In the present study, multivariate analysis showed that the depth of PV wall invasion (to the tunica media or tunica intima vs no invasion or to the tunica adventitia only), the number of involved lymph nodes (Ն2 vs Ͻ2) and the volume of blood transfusion (Ն3 vs Յ2 U) were independent factors for long-term and disease-free survival.…”

“…1,[13][14][15][16]18 However, only a few reports have described in detail the correlation between the depth of PV wall invasion and survival. 13,14 In the present study, multivariate analysis showed that the depth of PV wall invasion (to the tunica media or tunica intima vs no invasion or to the tunica adventitia only), the number of involved lymph nodes (Ն2 vs Ͻ2) and the volume of blood transfusion (Ն3 vs Յ2 U) were independent factors for long-term and disease-free survival. Remarkably, the 3-year survival in the case of superficial PV wall invasion was similar to that of patients who did not require PV resection.…”

“…In many centers, preoperative angiography with a portogram is still commonly used to evaluate vascular involvement. Nakao et al 13 was the first to report the correlation between angiographic type on portogram findings and the pathological grade of carcinoma invasion into the PV. Similarly, the present study confirms the existence of a correlation between angiographic type on the portogram and the depth of PV wall invasion.…”