Portal vein resection during pancreatectomy for pancreatic head adenocarcinoma. Scope of current opinions and own experiences.

* Authors’ results were presented at the 66th Congress of Polish Surgeons Society in Warsaw (2013) According to expert consensus, cases with distal metastases, radiographic evidence of superior mesenteric vein (SMV) and portal vein abutment, distortion, tumor thrombus or venous encasement or no clear fat plane around the celiac axis, hepatic artery and superior mesenteric artery (SMA) are not treated as resectable (1). Some tumors can be treated as borderline resectable (1). Cancer infiltrating arteries is suspected to spread through nerve plexuses and lymphatic tissue surrounding those vessels which gives positive margins of resections. That fact limits oncological radicality of procedures which involve arterial resection (2-4). In contrast, portal vein confluence is not surrounded by perivascular neural plexuses and lyphatic tissue. Involvement of the portal vein, such as tumor abutment with or without impingement, narrowing of the lumen, encasement or thrombus with a patent lumen, encasement or thrombus with patent lumen, does not impede the achievement of a R0, oncologically radical resection (1, 4). Also some selected cases of arterial involvement are bordeline resectable (gastroduodenal artery encasement up to the hepatic artery with either short segment encasement or direct abutment of hepatic artery, without extension to the celiac axis, and cases of SMA abutment not exceed >180 of the circumference of the vessel wall) (1). Surgical Technique