{"entity":{"id":"vascular-resection-pancreatic","kind":"term","name":"Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)","aka":["Venous resection in pancreatectomy","Portal vein resection","Superior mesenteric vein resection and reconstruction","Arterial resection in pancreatic surgery","Appleby procedure","Vascular reconstruction pancreatoduodenectomy"],"tldr":"When a pancreatic cancer touches or narrows the big vein behind the pancreas, surgeons can cut out that segment of vein and rebuild it during the operation, which turns a borderline tumour into a removable one. Removing and rebuilding an artery is far riskier and is done only in selected patients in specialist centres, usually after chemotherapy has shrunk the tumour.","summary":"Venous involvement no longer rules out resection: the resectability criteria treat contact, narrowing or occlusion of the superior mesenteric or portal vein as borderline resectable provided the vein can be reconstructed, and the NCCN and international consensus define the limits by whether suitable vessel above and below remains for anastomosis (Isaji 2018). A meta-analysis of 27 studies and 9,005 patients (1,587 with portal or superior mesenteric vein resection) found venous resection associated with slightly higher postoperative mortality, a 9-point higher rate of R1 or R2 resection and worse survival than resection without it, which the authors attributed to more advanced disease in that group rather than to the technique (Giovinazzo 2016); in practice venous resection is routine in high-volume centres because the alternative is no resection. Arterial resection is different. In 26 retrospective studies (366 patients with arterial resection against 2,243 without) it carried about five times the perioperative mortality (odds ratio 5.04) and poor long-term outcome, and the authors concluded it may be justified only in highly selected patients, ideally within trials (Mollberg 2011). The distal pancreatectomy with coeliac axis resection (modified Appleby procedure) for body tumours encasing the coeliac axis, and arterial resections after neoadjuvant chemotherapy for locally advanced disease, are performed in specialist centres and reported as series. NICE NG85 asks that a specialist pancreatic multidisciplinary team makes these decisions (1.2.1). The resected vein or artery is examined by the pathologist, and true invasion of the vessel wall (rather than adherence to inflamed tissue) is one of the markers of a worse outlook.","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Pancreaticoduodenectomy","links":[{"label":"Giovinazzo, Br J Surg 2016: meta-analysis of portal and superior mesenteric vein resection in pancreatic resection (9,005 patients)","url":"https://doi.org/10.1002/bjs.9969"},{"label":"Mollberg, Ann Surg 2011: arterial resection during pancreatectomy, systematic review and meta-analysis","url":"https://doi.org/10.1097/sla.0b013e31823ac299"},{"label":"Isaji, Pancreatology 2018: international consensus on the definition and criteria of borderline resectable pancreatic cancer","url":"https://doi.org/10.1016/j.pan.2017.11.011"},{"label":"NICE NG85: pancreatic cancer in adults (diagnosis 1.1, staging 1.3, nutrition 1.6, biliary obstruction 1.7, resectable disease 1.8)","url":"https://www.nice.org.uk/guidance/ng85/chapter/Recommendations"}],"tags":["gi","pancreatic"],"related":[],"cancers":["pancreatic","borderline-resectable-pdac","locally-advanced-pdac","resectable-pdac"],"sections":[],"technologies":["robotic-surgery"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["nccn-resectability-criteria-pancreatic","whipple","resectability","r0-r1-margin-pancreatic","surgical-morbidity","downstaging"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Procedures"},"route":"/terms/vascular-resection-pancreatic/","neighbours":{"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"technology":[{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"}],"term":[{"id":"downstaging","kind":"term","name":"Downstaging and conversion therapy","route":"/terms/downstaging/"},{"id":"r0-r1-margin-pancreatic","kind":"term","name":"R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting","route":"/terms/r0-r1-margin-pancreatic/"},{"id":"nccn-resectability-criteria-pancreatic","kind":"term","name":"Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)","route":"/terms/nccn-resectability-criteria-pancreatic/"},{"id":"resectability","kind":"term","name":"Resectable, borderline resectable and unresectable","route":"/terms/resectability/"},{"id":"surgical-morbidity","kind":"term","name":"Surgical morbidity and postoperative complications","route":"/terms/surgical-morbidity/"},{"id":"whipple","kind":"term","name":"Whipple procedure (pancreaticoduodenectomy)","route":"/terms/whipple/"}]}}