Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Jean Robert Delpero, Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
- Second opponent: Professor Stephen J. Wigmore, Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Third member and chair of the evaluation committee: Associate Professor Kirsten Krohg-Sørensen, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor II Tor Inge Tønnessen, Faculty of Medicine, University of Oslo
Principal Supervisor
Senior Consultant Knut Jørgen Labori, Oslo University Hospital
Summary
The standard treatment for patients with resectable pancreatic cancer is surgery followed by adjuvant chemotherapy. In patients with tumour involvement of the superior-mesenteric/portal vein, vein resection has to be performed at the same time as pancreatic resection in order to achieve tumour removal.
The aim of this thesis was to assess short – and long-term results after pancreatoduodenectomy with and without venous resection as well as assessment of venous reconstruction with the use of cold-stored venous allograft retrieved after organ harvesting procedures. Furthermore, pathological findings in specimens retrieved after pancreatoduodenectomy with venous resection were evaluated.
The results showed an increased complication rate in patients undergoing pancreatoduodenectomy with venous resection compared to patients undergoing a standard pancreatoduodenectomy. The survival, however, was comparable.
The use of allograft for venous reconstruction was associated with acceptable complication rates comparable to reconstruction without graft. Graft rejection may contribute to severe stenosis in the long-term.
Pancreatoduodenectomy with venous resection was associated with an increased frequency of postoperative haemorrhage. Increased preoperative serum bilirubin and leakage from the pancreatic anastomosis were identified as risk factors for bleeding.
Microscopic findings revealed that growth of tumour cells in the superior-mesenteric groove precluded the possibility for microscopic complete tumour removal in most patients undergoing pancreatoduodenectomy with venous resection.
Overall, though major vein resection during pancreatic surgery was associated with an increased complication rate compared to standard resection, the long-term results were comparable. Venous allograft for use in vein reconstruction is safe. The chance of achieving microscopic complete tumour removal after this procedure, is highly limited.
Additional information
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