Resultados perioperatorios y sobrevida alejada de la pancreatoduodenectomía con resección vascular

Abstract

Pancreaticoduodenectomy with vascular resection. Perioperative results and longterm survivalBackground: Pancreaticoduodenectomy (PDD) with vascular resection (VR) of the portal and superior mesenteric vein for locally advanced periampullary tumors is controversial. Aim: To evaluate the perioperative results and long-term survival of PDD with VR. Patients and Methods: Retrospective study. We included patients with periampullary tumors who underwent a PDD with VR between 1990 and 2008. We compared perioperative results and long-term survival with PDD without VR during the same period. We compared survival with non resected patients. Results: One hundred and eighty eight patients underwent a PDD, a VR was performed in 8 (4%) patients (Age: 58 ± 14 years, Male: 4). Morbidity for PDD with and without VR was 75% and 59% (p = ns). Surgical mortality for PDD with and without VR was 0% and 8% (p = ns). In 6 of 8 patients the diagnosis was pancreatic cancer and histopathologic confirmation of vascular invasion was present in 4 patients. Long-term survival for patients with PDD with and without VR was similar (median 25 and 16 months; p = ns). Survival for patients with PDD with VR was superior to non resected patients (median 25 and 3 months; p = 0.0001). Conclusions: PDD with VR has similar perioperative results and long-term survival to PDD without VR. The survival reached with this type of surgery is far superior to non resected patients.

Impact of lymph node staging systems in predicting outcome in patients with ampullary cancer

“…Lymph node positivity has been reported as a marker of poor prognosis in patients undergoing pancreatoduodenectomy. 20,21,25,26 The effect of number of lymph nodes retrieved on long-term survival has also been studied with some support in literature. 22,28 However, our study including the one by Farid et al 10 Previous studies have tried to validate LNR as a categorical variable by either using cut-off levels 10,25 or by grouping them.…”

“…20,21,25,26 The effect of number of lymph nodes retrieved on long-term survival has also been studied with some support in literature. 22,28 However, our study including the one by Farid et al 10 Previous studies have tried to validate LNR as a categorical variable by either using cut-off levels 10,25 or by grouping them. 4,9,20,22 Farid et al 10 & Shamseddine et al 28 found the LNR ＞0.2 to be an important factor in determining prognosis.…”

Resultados actuales de la pancreatoduodenectomía para el tratamiento de los tumores periampulares y análisis de factores pronósticos de sobrevida

“…ganglios de la arteria hepática, del ligamento hepatoduodenal y los ganglios en relación a la arteria mesentérica superior. En casos de invasión local de la vena porta o mesentérica superior se realiza una resección de esta en casos seleccionados 8 . Se toma muestra para biopsia contemporánea de los márgenes de la vía biliar y de la sección del páncreas.…”