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BACKGROUND: The incidence of carcinoma of the pan creas is increasing in the world. Pancreatic carcinoma i characterized by early local extension to contiguous struc tures and metastases to regional lymph nodes and the liver This study was conducted to increase the rate of pancrea toduodenectomy combined with vascular reconstruction. METHODS: Pancreatoduodenectomy with vascular recon struction was performed for 79 patients at a number of hos pitals in Fujian Province, Zhejiang Province, Shanghai an Xinjiang Uyghur Autonomous Region from April 1994 t December 2003. One of these patients also underwent righ hemicolectomy; but all received through superior mesen teric vein (SMV)-portal vein (PV) reconstruction. Th reconstructions of the superior mesenteric artery ( SMA and hepatic artery (HA) were performed in 4 patients, and reconstructions of the SMA or HA were carried out in 7 and 4 patients respectively. Partial reconstruction of the inferio vena cava (ICV) was done in 2 patients when the tumo was adhering to the wall of the inferior caval vein. RESULTS: Four patients died during the peri-operative pe riod, with a mortality rate of 5%. No complications such a biliary or pancreatic fistulae or artificial blood vessel infec tion were noted. Histological examination showed one pa tient with neuroendocrine cancer and the other 78 patient with adenocarcinoma of the pancreatic head. Resected en dothelia and vascular margins proved to be microscopicall tumor-free. Follow-up for 3 months to 10 years for all ex cept two patients showed 7 of the 9 patients who had under- gone resection and reconstruction of the SMA and HA died 7 months or 4 years after operation and 37 survived for over 3 years and 12 for more than 5 years. The rest are still under follow-up. CONCLUSION: Pancreatoduodenectomy with vascular re- construction for carefully selected patients with carcinoma of the pancreatic head has proved to be a safe and reliable treatment, capable of raising the rates of tumor resection and survival.
BACKGROUND: The incidence of carcinoma of the pan creas is increasing in the world. Pancreatic carcinoma i characterized by early local extension to contiguous struc tures and metastases to regional lymph nodes and the liver This study was conducted to increase the rate of pancrea toduodenectomy combined with METHODS: Pancreatoduodenectomy with vascular reconstruction was performed for 79 patients at a number of hos pitals in Fujian Province, Zhejiang Province, Shanghai an Xinjiang Uyghur Autonomous Region from April 1994 t December 2003. One of these patients also underwent righ hemicolectomy; but all received through superior mesentery vein (SMV) -portal vein (PV) reconstruction. Th reconstructions of the superior mesenteric artery (SMA and hepatic artery (HA) were performed in 4 patients, and reconstructions of the SMA or HA were carried out in 7 and 4 patients respectively. Partial reconstruction of the inferio vena cava (ICV) was done in 2 patients when the tumo was adhering to the wall of the inferior caval vein. RESULTS: Four patients died during the peri-operative pe riod, with a mortality rate of 5%. No complications such a biliary or pancreatic fistulae or artificial blood vessel infections have been noted Histological examination showed one pa tient with neuroendocrine cancer and the other 78 patient with adenocarcinoma of the pancreatic head. Resected en dothelia and vascular margins proved to be microscopicall tumor-free. Follow-up for 3 months to 10 years for all ex cept two patients showed 7 of the 9 patients who had under-gone resection and reconstruction of the SMA and HA died 7 months or 4 years after operation and 37 survived for more than 3 years and 12 for more than 5 years. The rest are still under follow- up. CONCLUSION: Pancreatoduodenectomy with vascular re- construction for carefully selected patients with carcinoma of the pancreatic head has proved to be a safe and reliable treatment, capable of raising the rates of tumor resection and survival.