Surgical outcomes in patients with pancreatic body and tail cancer invading the main veins

The aim of the study was to demonstrate the safety and satisfactory outcomes of surgical treatment in patients with ductal cancer of the body and tail of the pancreas with invasion of the main veins using distal subtotal resection of the pancreas with resection of the superior mesenteric and / or portal veins. Materials and methods: Distal subtotal resection of the pancreas with resection of the superior mesenteric and / or portal veins was performed in 29 patients with ductal cancer of the body and tail of the pancreas. Parietal resection of the main veins with a length of 1.0 to 3.0 cm using a parietal suture was performed in 15 (51.7%) patients, and circular resection with a length of 1.5 to 5.0 cm was carried out in 14 (48.3%) patients. In the circular resection subset, 11 people had an end-to-end anastomosis, 2 had plastic surgery using a Gore-Tex synthetic graft, and 1 underwent an autologous vein plastic surgery. Compression of the portal vein during surgery lasted from 10 to 16 minutes with the creation of a direct end-to-end anastomosis and from 12 to 27 minutes with the use of a graft. Damage from the tumor to neighboring organs required a liver resection in 1 (3.5%) patient, wedge resection of the stomach wall in 3 (10.3 %) patients, adrenalectomy in 2 (6.9 %) subjects, small intestine resection in 2 (6.9 %) patients, one diaphragm resection, one nephrectomy, and one hemicolectomy. The duration of the operations ranged from 2 to 6.5 hours, and the volume ofblood loss ranged from 300 mL to 5.6 L. Results: R0 surgery was performed in 89.6 % of patients, R1 in 6.9 %, and R2 surgery in 3.5% of cases. Histopatho-logical examination of the surgical material revealed retroperitoneal invasion in 69.0% of patients, perineural invasion in 65.5%, and invasion of the superior mesenteric and/ or portal veins in 55.2% of cases. Complications occurred in 51.7% of patients, the incidence of Clavien-Dindo Grade III or higher complications was 34.5%. All complications were controlled with conservative treatment; there were no deaths. Long-term treatment outcomes: The one- and three-year overall survival rates were 74.6% and 14.9%, respectively (median 14.6 months), the progression-free survival rates were 31.0% and 15.5%, respectively (median 8.0 months). A comparison of results in 26 patients who underwent R0 surgery and 3 patients who underwent R+ surgery did not reveal statistically significant differences. Conclusion: Distal subtotal resection of the pancreas with resection of the superior mesenteric and / or portal veins is relatively safe and helps to improve the duration and quality of life of patients with ductal cancer of the body and tail of the pancreas.