Portal Vein Resection During Pancreaticoduodenectomy for Cancer

Pancreaticoduodenectomy is the treatment of choice for adenocarcinoma of the head of the pancreas. However, this treatment is applicable only to a minority with the disease. Approximately one-third present with locally advanced, nonmetastatic disease. In view of the close anatomical proximity between the head of the pancreas and the portal/superior mesenteric vein confluence, it is logical for surgeons to seek to expand the pool of patients who may benefit from pancreaticoduodenectomy by undertaking en bloc resection of the vein. However, portal vein resection during pancreaticoduodenectomy is controversial. Unresolved issues remain about the terminology (as partial circumference excision may be classified as portal vein resection), indications and outcome. Given these variations and the small proportion of patients having pancreatic cancer surgery who undergo portal vein resection, it is difficult to construct a suitably designed randomised trial to address this question. Under these circumstances, surgeons will continue to base their practice on summative evidence from case series and the two articles presented here summarise the arguments for and against portal vein resection during pancreaticoduodenectomy. Ajith Siriwardena Professor of Hepatobiliary Surgery, University of Manchester Consultant Hepatobiliary Surgeon, Manchester Royal Infirmary E: ku.shn.cmmc@anedrawiris.htija