BACKGROUND Pancreatoduodenectomy with venous resection is considered standard of care for patients with tumour involvement of the superior mesenteric/portal vein (SMV/PV) and deemed justified if an R0-resection can be achieved. The aim of this study was to provide a detailed pathology assessment of the site and extent of margin involvement in specimens resulting from pancreatoduodenectomy with venous resection. METHODS Retrospective observational study including patients undergoing pancreatoduodenectomy with or without venous resection for pancreatic ductal adenocarcinoma between 2015 and 2017. Detailed histopathological mapping of the tumour and its relationship to the margins was undertaken. RESULTS 98 patients met the inclusion criteria. An R0-resection, based on 1 mm clearance, was achieved in 16 of 73 patients without venous resection and in 1 of 25 patients with venous resection (p = 0.063). The surface of the SMV-groove was the most frequently involved margin (23 of 25 patients with venous resection, 37 of 73 patients without venous resection; p < 0.001). The broad invasive tumour front as well as the absence of peripancreatic fat at the SMV-groove were the reasons for these findings. CONLUSION An R0-resection following pancreatoduodenectomy with venous resection for ductal adenocarcinoma can rarely be achieved due to microscopical involvement of the SMV-groove.

中文翻译：

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胰十二指肠切除术与静脉切除术治疗导管腺癌极少能达到完全切除（R0）的目的。

背景技术静脉十二指肠胰十二指肠切除术被认为是肠系膜/门静脉上肿瘤（SMV / PV）累及患者的护理标准，并认为是否可以进行R0切除是合理的。这项研究的目的是提供详细的病理学评估，以评估胰十二指肠切除术静脉切除术所致标本的部位和边缘受累程度。方法回顾性观察性研究，包括2015年至2017年间接受胰十二指肠切除术或无静脉切除的胰腺导管腺癌患者。对肿瘤进行了详细的组织病理学定位及其与切缘的关系。结果98例患者符合纳入标准。根据1毫米的间隙进行R0切除，在73例无静脉切除的患者中有16例在25例进行静脉切除的患者中有1例达到了（p = 0.063）。SMV槽的表面是最常受累的边缘（25例行静脉切除的患者中的23例，73例未行静脉切除的患者中的37例； p <0.001）。这些发现的原因是广泛的浸润性肿瘤前沿以及SMV槽处不存在胰周脂肪。结论胰十二指肠切除术后伴有静脉切除的导管腺癌的R0切除由于SMV槽的微观介入而很少能实现。这些发现的原因是广泛的浸润性肿瘤前沿以及SMV槽处不存在胰周脂肪。结论胰十二指肠切除术后伴有静脉切除的导管腺癌的R0切除由于SMV槽的微观介入而很少能实现。这些发现的原因是广泛的浸润性肿瘤前沿以及SMV槽处不存在胰周脂肪。结论胰十二指肠切除术后伴有静脉切除的导管腺癌的R0切除由于SMV槽的微观介入而很少能实现。