Clinical impact of pancreaticoduodenectomy for pancreatic cancer with resection of the secondary or later branches of the superior mesenteric vein

PURPOSE To evaluate the feasibility of pancreaticoduodenectomy with resection of the second jejunal vein (J2V) for pancreatic ductal adenocarcinoma (PDAC). METHODS Among 114 patients with PDAC undergoing pancreaticoduodenectomy with portal-superior mesenteric vein resection (PVR), surgical outcomes, and prognoses of 10 patients with resection of J2V or later branches of the superior mesenteric vein (J2VR) were compared to 104 patients with PVR above J2V (standard PVR). The reconstruction methods in the J2VR group were reviewed. RESULTS There were no significant differences in the operative time (470 versus [vs.] 435 min), morbidity (30 vs. 27%), presence of portal vein stenosis (10 vs. 5%) or thrombosis (10 vs. 1%), and induction of adjuvant therapy (80 vs. 88%) between the J2VR and standard PVR groups, although blood loss was higher in the J2VR group (1184 vs. 494 ml; p=0.002). R0 proportion and 2-year survival rates were not significantly worse in the J2VR group compared to the standard PVR group (90 and 88%; 67 and 45%, respectively). At least one branch of the superior mesenteric vein was reconstructed in the J2VR group. CONCLUSION Pancreaticoduodenectomy with J2VR for PDAC can be safely performed with a satisfactory overall survival rate.