Whipple operation with resection of portal/upper mesenteric vein without vascular reconstruction for tumoral thrombosis of vessels of the portal vein system
Introduction. Experience of performance of pancreaticoduodenal resection with resection and complete ligature of upper mesenteric or portal vein in 4 patients for total tumoral occlusion of the portal vein system vessels by pancreatic head and processus uncinatus is adduced.
Маterials and methods. In 2015 - 2017 yrs period 4 patients were operated for tumor of right anatomic-surgical pancreatic segment with tumoral invasion into portal/upper mesenteric vein with total (absence of the blood flow) or subcompensated (over 80%) thrombosis of these vessels.
Results. In 3 patients during pancreatico-duodenal resection vascular reconstruction was not performed and distal end of upper mesenteric vein was sutured tightly. In one patient a circular venous anastomosis was formatted in end to end fashion between portal vein and dilated collateral vein, which have branched from upper mesenteric vein. At average, the operation duration have constituted (390 ± 47) min and postoperative period - (18 ± 4.2) days, with lethality 25% (one woman-patient died).
Conclusion. Pancreatico-duodenal resection with ligature of upper mesenteric vein without formation of vascular anastomosis in its tumoral occlusion is secure and possible in thoroughly selected patients.
2. Flis V, Potrc S, Kobilica N, Ivanecz A. Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection. Radiol Oncol. 2016 Jul;19;50(3):321-8.
3. Addeo P, Nappo G, Felli E, Oncioiu C, Faitot F, Bachellier P. Management of the splenic vein during a pancreaticoduodenectomy with venous resection for malignancy. Updates Surg. 2016 Sep;68(3):241-6.
4. Chua TC, Wang F, Maher R, Gananadha S, Mittal A, Samra JS. Endovascular stenting of mesenterico-portal vein stenosis to reduce blood flow through venous collaterals prior to pancreatoduodenectomy. Langenbecks Arch Surg. 2015 Jul;400(5):629-31.
5. Tang J, Abbas J, Hoetzl K, Allison D, Osman M, Williams M, Zelenock GB. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy. Case report. Ann Med Surg (Lond). 2014 Oct 2;3(4):137-40.
6. Maemura K, Mataki Y, Kurahara H, Iino S, Sakoda M, Ueno S, et al. Clinical impact of intraoperative navigation using a Doppler ultrasonographic guided vessel tracking technique for pancreaticoduodenectomy. Int Surg. 2014 Nov-Dec;99(6):770-8.
7. Pilgrim CH, Tsai S, Tolat P, Patel P, Rilling W, Evans DB, Christians KK. Optimal management of the splenic vein at the time of venous resection for pancreatic cancer: importance of the inferior mesenteric vein. J Gastrointest Surg. 2014 May;18(5):917-21.
8. Strasberg SM, Bhalla S, Sanchez LA, Linehan DC. Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure: comparison with collateral vein pattern in cases of sinistral portal hypertension. J Gastrointest Surg. 2011 Nov;15(11):2070-9.
9. Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM, Sarmiento JM. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg. 2010 Sep;211(3):316-24.
10. Cusack JC Jr, Fuhrman GM, Lee JE, Evans DB. Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg. 1994 Oct;168(4):352-4.
Copyright (c) 2018 Klinicheskaia khirurgiia
This work is licensed under a Creative Commons Attribution 4.0 International License.