Background : We hypothesized that preoperatively planned portal vein resection (PVR), which prevents from approaching tumors, improves survival in patients with pancreatic head cancer contact with the portal vein (PhC-PV).

Methods : This is a retrospective, bi-institutional study of patients undergoing pancreatoduodenectomy (PD) for PhC-PV from 2009 to 2018. We compared clinical data of patients who underwent PD with preoperatively planned PVR (pl-PVR) and those who underwent conventional PD (cPD) in which decision to perform PVR was made intraoperatively.

Results : In 401 patients, 176 patients with resectable PhC-PV (R-PhC-PV) and 225 patients with borderline resectable PhC-PV invasion (BR-PhC-PV). 151 patients (37.7%) underwent pl-PVR, the remaining 250 patients (62.3%) underwent cPD. R0 resection was achieved in 124 patients (82.1%) in the pl-PVR group, compared with 177 (70.8%) of those in the cPD group (P = 0⋅01), although perioperative outcomes were comparable between the groups. Median overall survival (OS) was longer in the pl-PVR group than in the cPD group (25 vs 21 months; P = 0.008). In 176 patients with R-PhC-PV, 53 patients (30.1%) underwent pl-PVR. The remaining 123 patients (69.9%) underwent cPD. Tumor characteristics were similar between the 2 groups. The local recurrence rate of patients in the planned PVR group (28.3%) was lower than that of the cPD group (44.7%; P = 0.041). Median OS was longer in the pl-PVR group than in the cPD group (32 vs 27 months; P = 0.011).

Conclusions : The preoperative decision to perform PVR improves survival by enhancing local control of PhC-PV, even in the patients with R-PhC-PV.