Impact of portal vein resection with splenic vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?

Tanaka, Masayuki; Ito, Hiromichi; Y, Ono; Matsueda, Kiyoshi; Mise, Yoshihiro; Ishizawa, Takeaki; Inoue, Yosuke; Takahashi, Yu; Hiratsuka, Makiko; Unno, T; Saiura, Akio

doi:10.1016/j.surg.2018.08.025

Cited by 41 publications

(56 citation statements)

References 24 publications

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“…However, extended resection of the stomach with TP involves functional and structural dysfunction, resulting in worsening of the patient's nutritional status. Tanaka et al reported the risk for varices is dependent on the number of the gastric drainage veins preserved [5]. At least one gastric draining vein must be preserved to avoid venous congestion of the subtotal or whole stomach when performing TP.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of gastric venous congestion in association with extended resection of pancreas: a case report

et al. 2020

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Background: Total pancreatectomy is performed for chronic pancreatitis, tumors involving the entire pancreas or remnant pancreas after pancreatectomy. Gastric venous congestion and bleeding may be associated with total pancreatectomy. We report the case of a patient who underwent left gastric vein to splenic vein bypass to relieve gastric venous congestion during total pancreatectomy for remnant pancreatic cancer. Case presentation: A 60-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy for cancer of the pancreatic head. A follow-up computed tomography revealed a low-density tumor of the remnant pancreas. The pathological diagnosis was adenocarcinoma on endoscopic ultrasound-fine needle aspiration. Total resection of the remnant pancreas was performed for the tumor 3 years after the initial surgery. We ligated the splenic vein at the point of distal side of the left gastric vein confluent. Immediately, the vein congestion around the stomach was confirmed. We found the stenosis of the confluent between the left gastric vein and splenic vein. We subsequently anastomosed the left gastric vein and splenic vein, following which the gastric venous congestion was relieved. Conclusion: In cases wherein all the drainage veins from the stomach are removed, an anastomosis between the left gastric vein and splenic vein can be effectively used to prevent gastric venous congestion and bleeding after total pancreatectomy.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of gastric venous congestion in association with extended resection of pancreas: a case report

et al. 2020

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“…Because we usually separate the omentum from the colon when we perform a PD, our experiences supported Ono and Ismael’s opinions. Recently, some authors [10, 11] have shown that the preservation of collateral veins prevents LSPH. Considering these findings, preservation of many drainage vein of splenic flow may reduce the risk of LSPH.…”

Section: Discussionmentioning

confidence: 99%

Treatment of bleeding from a portion of pancreatojejunostomy after pancreaticoduodenectomy with division of the splenic vein: two case reports

et al. 2019

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Background There is no definitive strategy for gastrointestinal bleeding due to left-sided portal hypertension after pancreaticoduodenectomy (PD) for pancreatic cancer (PC) with concomitant portal vein resection (PVR). Case presentation Case 1: A 70-year-old woman underwent a PD for PC with PVR. Seven years after her surgery, she suffered severe anemia with suspected gastrointestinal bleeding. Computed tomography scan (CT) revealed varices at a portion of the pancreaticojejunostomy (PJ). Angiography revealed that splenic venous flow drained into the varices and then into the portal vein. A diagnosis of bleeding varices of the PJ due to left-sided portal hypertension was made. Following a partial splenic artery embolization, her anemia improved. Case 2: An 80-year-old male underwent a PD for pancreatic head cancer combined with resection of the confluence of the portal and splenic veins with a reconstruction between the portal and superior mesenteric veins. Eighteen months after his surgery, he developed melena with negative endoscopy findings in his large and small bowel. CT revealed varices at the site of the PJ that communicated with the jejunal and portal veins. He underwent obliteration of the varices via a trans-portal-venous approach. As a result, he remained without melena until he died of PC 17 months after the embolization. Conclusions Left-sided portal hypertension following a PD with bleeding varices can be treated by interventional radiology with minimal invasiveness.

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“…The right colon is fully mobilized so that the vein ends can be apposed without tension when the gap is long. The SpV stump is either simply ligated or reconstructed with anastomosis to the outflow vessels including the PV/SMV, left renal vein, middle colic vein, gonadal vein and inferior mesenteric vein at the surgeon's discretion. All other components of the RPD procedure are as described for the SPD, with no differences in the depth of SMA dissection or extent of lymphadenectomy.…”

Section: Methodsmentioning

confidence: 99%

Regional pancreatoduodenectomy versus standard pancreatoduodenectomy with portal vein resection for pancreatic ductal adenocarcinoma with portal vein invasion

Oba

Ito

et al. 2020

BJS Open

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Background: Pancreatoduodenectomy (PD) with portal vein resection (PVR) is a standard operation for pancreatic ductal adenocarcinoma (PDAC) with portal vein (PV) invasion, but positive margin rates remain high. It was hypothesized that regional pancreatoduodenectomy (RPD), in which soft tissue around the PV is resected en bloc, could enhance oncological clearance and survival.Methods: This retrospective study included consecutive patients who underwent PD with PVR between January 2005 and December 2016 in a single high-volume centre. In standard PD (SPD) with PVR, the PV was skeletonized and the surrounding soft tissue dissected. In RPD, the retropancreatic segment of the PV was resected en bloc with its surrounding soft tissue. The extent of lymphadenectomy was similar between the procedures.Results: A total of 268 patients were included (177 SPD, 91 RPD). Tumours were more often resectable in patients undergoing SPD (60⋅5 per cent versus 38 per cent in those having RPD; P = 0⋅014), and consequently they received neoadjuvant therapy less often (7⋅9 versus 25 per cent respectively; P < 0⋅001). R0 resection was achieved in 73 patients (80 per cent) in the RPD group, compared with 117 (66⋅1 per cent) of those in the SPD group (P = 0⋅016), although perioperative outcomes were comparable between the groups. Median recurrence-free (RFS) and overall (OS) survival were 17 and 32 months respectively in patients who had RPD, compared with 11 and 21 months in those who had SPD (RFS: P = 0⋅003; OS: P = 0⋅004).Conclusion: RPD is as safe and feasible as SPD, and may increase the survival of patients with PDAC with PV invasion.

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Impact of portal vein resection with splenic vein reconstruction after pancreatoduodenectomy on sinistral portal hypertension: Who needs reconstruction?

Cited by 41 publications

References 24 publications

Surgical treatment of gastric venous congestion in association with extended resection of pancreas: a case report

Surgical treatment of gastric venous congestion in association with extended resection of pancreas: a case report

Treatment of bleeding from a portion of pancreatojejunostomy after pancreaticoduodenectomy with division of the splenic vein: two case reports

Regional pancreatoduodenectomy versus standard pancreatoduodenectomy with portal vein resection for pancreatic ductal adenocarcinoma with portal vein invasion

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