Introduction : R0 resection is imperative for better survival outcomes in pancreaticoduodenectomy (PD). Portal vein resection(PVR) is an important step in this regard but may have increased morbidity and mortality. We present the 10 year outcomes for PVR in our institute.

Methods : Analysis of prospectively maintained database from January 2010 to December 2019. Perioperative parameters, post-op complications, histopathology (as per LEEPP), R0 resection and survival in patients undergoing PVR during PD were analysed.

Results : 328 patients underwent pancreaticoduodenectomy out of which 39 patients (17.1%) underwent PVR. Mean age was 51.8±14.7 years. Carcinoma head of pancreas was present in 17 (43.5%) patients. Segmental resection with end-to-end anastomosis was done in 28 (71.7%), sleeve resection in 10 (25.6%) and interposition graft in 1 patient. Mean operative time was 461±143 minutes and operative blood loss was 1328±1000 ml. Major complications (Clavien Dindo 3 or more) were present in 12 (30.7%) patients which included bile leak, delayed gastric emptying and hemorrhage. Perioperative mortality happened in 6 (15%) patients. On HPE, R0 resection was in 74.4% patients. Median survival in these patients was 34 months with 5 year survival rate of 52%.

Conclusions : Although associated with increased perioperative mortality, PVR leads to better R0 resection rates and overall survival in patients undergoing pancreaticoduodenectomy. More meticulous surgical approach will lead to better perioperative outcomes as well.