Vascular resection and reconstruction in pancreatic tumors

Ahmet Türkoğlu; Abdullah Oğuz; Gizem Yaman; İbrahim Halil Öcal; Mesut Gül

doi:10.5281/zenodo.8140758

Authors

Ahmet Türkoğlu
Abdullah Oğuz
Gizem Yaman
İbrahim Halil Öcal
Mesut Gül

DOI:

https://doi.org/10.5281/zenodo.8140758

Keywords:

neoplasms, pancreatic procedure, Vascular surgical- negative surgical margins

Abstract

Objective: We aimed to to present our patients who underwent pancreaticoduodectomy with vascular resection and reconstruction for borderline pancreatic tumor.

Materials and methods: The retrospective study included six patients undergoing pancreaticoduodenectomy with portal vein resection due to locally advanced disease over a 2- year period. Demographic characteristics, symptoms, imaging findings, exploration findings of surgery, types of resections, perioperative complications, postoperative hospital stay were recorded.

Results: The patients were cosisted of 2 females and 4 males. Tumor location was in the head of the pancreas in 4 (66.7%) patients and in the body in 2 (33.3%) patients. Vasculary reconstruction was achieved by end-to-end anastomosis in 2 (33.3%) and primary closure in 4 (66.7%) cases. The hospital stay of the patients was 11 to 35 days. Intraoperative and postoperative blood product transfusion was not required in 3 of the cases. One patient was reoperated on the second postoperative day due to bleeding in the gastroduodenal anostomosis line and the bleeding was controlled. None of the patients developed pancreatic fistula.

Conclusions: In cases of pancreatic cancer with vascular invasion, vascular resection- reconstruction is inevitable to provide a negative surgical margin. Vascular resection and reconstruction can be performed safely similar to standard pancreatic surgery.

References

Ravikumar R, Sabin C, Hilal MA, Bramhall S, White S, Wigmore S, et al. Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study. J Am Coll Surg. 2014;218(3):401-11.

Dumitrascu T, Martiniuc A, Brasoveanu V, Stroescu C, David L, Dima S, et al. One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma. Chirurgia. 2018;113:363-373.

Batool S, Malik AA, Bari H, İslam IU, Hanif F. Vascular Resection and Reconstruction in Pancreatic Tumours. J Coll Doktorları Surg Pak. 2018;28(6):485-487.

Zaky AM, Wolfgang CL, Weiss MJ, Javed AA, Fishman EK, Zaheer A. Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment Planning. Radiographics. 2017;37(1):93-112.

Cai Y, Gao P, Li Y, Wang X, Peng B. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc. 2018;32:4209–4215.

Zhang XM, Fan H, Kou JT, Zhang XX, Li P, Dai Y, et al. Resection of portal and/or superior mesenteric vein and reconstruction by using allogeneic vein for pT3 pancreatic cancer. J Gastroenterol Hepatol. 2016;31(8):1498-503.

Martin D, Petermann D, Fontanella S, Pu Y, Halkic N, Demartines N, et al. Pancreatic adenocarcinoma with histologically proven portal vein infiltration: what is the outcome? Eur J Gastroenterol Hepatol. 2018;30(12):1507-1513.

Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Ann Surg. 1996;223(2):154-62.

Ouaissi M, Hubert C, Verhelst R, Astarci P, Sempoux C, Jouret-Mourin A, et al. Vascular Reconstruction During Pancreatoduodenectomy for Ductal Adenocarcinoma of the Pancreas Improves Resectability but does not Achieve Cure. World J Surg. 2010;34:2648–2661.

Gage MM, Reames BN, Ejaz A, Sham J, Fishman EK, Weiss MJ, et al. Pancreaticoduodenectomy with en bloc vein resection for locally advanced pancreatic cancer: a case series without venous reconstruction. Chin Clin Oncol. 2018;7(1):7.

Zhang XM, Zhang J, Fan H, He Q, Lang R. Feasibility of portal or superior mesenteric vein resection and reconstruction by allogeneic vein for pancreatic head cancer—a case-control study. BMC Gastroenterology. 2018;18:49.