Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Radiology, Tokyo Medical University, Tokyo, Japan.
J Gastrointest Surg. 2018 Jul;22(7):1179-1185. doi: 10.1007/s11605-018-3722-0. Epub 2018 Mar 8.
BACKGROUND/PURPOSE: The proximal jejunal vein which branches from the dorsal side of the superior mesenteric vein (SMV) usually drains the inferior pancreatoduodenal veins (IPDVs) and contacts the uncinate process of the pancreas. We focused on this vein, termed the proximal dorsal jejunal vein (PDJV), and evaluated the anatomical classification of the PDJV and surgical outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) with PDJV involvement (PDJVI).
The jejunal veins that branch from the dorsal side of the SMV above the inferior border of the duodenum are defined as PDJVs. We investigated 121 patients who underwent upfront pancreaticoduodenectomy for PDAC between 2011 and 2017; PDJVs were resected in all patients. The anatomical classification of PDJV was evaluated using multidetector computed tomography. Surgical and prognostic outcomes of pancreticoduodenectomy for PDAC with PDJVI were evaluated.
The PDJVs were classified into seven types depending on the position of the first and second jejunal veins relative to the superior mesenteric artery. In all patients, the morbidity and mortality rates were 15.7 and 0.8%, respectively. The rates for parameters including SMV resection, presence of pathological T3-4, R0 resection, and 3-year survival were 46.2, 92.3, 92.3, and 61.1%, respectively, when there was PDJVI (n = 13). When there was no PDJVI (n = 108), the rates were 60.2, 93.5, 86.1, and 58.3%, respectively. Overall, there were no significant differences.
Pancreaticoduodenectomy with PDJV resection is feasible for PDAC with PDJVI and satisfactory overall survival rates are achievable. It may be necessary to reconsider the resectability of PDAC with PDJVI.
背景/目的：发自肠系膜上静脉（SMV）背侧的近段空肠静脉通常引流下胰十二指肠静脉（IPDVs），并与胰腺钩突接触。我们关注这条静脉，称之为近段背侧空肠静脉（PDJV），并评估了 PDJV 受累的胰腺导管腺癌（PDAC）患者的 PDJV 解剖分类和手术结果。
发自十二指肠下缘于 SMV 背侧的空肠静脉被定义为 PDJVs。我们调查了 2011 年至 2017 年间接受胰十二指肠切除术治疗 PDAC 的 121 例患者；所有患者均切除 PDJV。使用多排螺旋 CT 评估 PDJV 的解剖分类。评估 PDAC 合并 PDJVI 的胰十二指肠切除术的手术和预后结果。
PDJVs 根据第一和第二空肠静脉相对于肠系膜上动脉的位置分为七种类型。在所有患者中，发病率和死亡率分别为 15.7%和 0.8%。当存在 PDJVI（n=13）时，SMV 切除、存在病理性 T3-4、R0 切除和 3 年生存率的参数率分别为 46.2%、92.3%、92.3%和 61.1%。当不存在 PDJVI（n=108）时，这些比率分别为 60.2%、93.5%、86.1%和 58.3%。总体而言，差异无统计学意义。
对于 PDAC 合并 PDJVI，PDJV 切除术的胰十二指肠切除术是可行的，并且可以实现令人满意的总生存率。可能有必要重新考虑 PDJVI 合并 PDAC 的可切除性。
