Portal vein involvement in pancreatic cancer: a sign of unresectability?

Overview

Although the prognosis remains poor, surgical exploration with complete resection provides the only potential cure for patients with adenocarcinoma of the pancreas. However, only 15% to 20% of patients are candidates for resection because of the presence of distant tumor outside the confines of resection or because of locally advanced disease. Even though isolated portal vein involvement has classically been a contraindication for resection, PVR can be performed safely with a low perioperative mortality rate. Besides PV involvement and size, the distribution of histopathologic prognostic factors is no different between patients undergoing PVR and those undergoing standard pancreatic resection. Importantly, overall survival is similar between both groups. Therefore, suspected isolated PV involvement frequently does not preclude operability and, by itself, should not be a contraindication to pancreatic resection.