Intraportal endovascular ultrasound for portal vein resection in pancreatic carcinoma.

BACKGROUND/AIMS: Intraportal endovascular ultrasound (IPEUS) has been reported to be the most precise diagnostic procedure for the accurate diagnosis of portal vein/superior mesenteric vein (PV/SMV) invasion in patients with pancreatic cancer. In this study, we evaluated the clinical significance of the length of PV/SMV invasion measured by IPEUS METHODOLOGY: Twenty-six consecutive patients who underwent the pancreatic resection and IPEUS using an autopull-back device between January, 1997 and September, 2000 were retrospectively evaluated. The length of PV/SMV invasion was measured by reviewing the videotapes recorded during the operation. Clinicopathological data and survival were analyzed.

RESULTS

The percentage of PV/SMV invasion was 46%, all of which were treated by PV/SMV resection. The cases without PV/SMV invasion showed significantly longer survival rate. The cases with < or = 18mm PV/SMV invasion, however, achieved a comparable 2-year survival rate of 28% whereas no patient with > 18mm PV/SMV invasion survived more than 18 months after the resection.

CONCLUSIONS

Involvement of the PV/SMV by pancreatic carcinoma seems to be related to the extent of the disease and the PV/SMV involvement > 18mm is associated with a poor prognosis due to high rate of tumor positive margin even with radical operation.