Major Venous Repair or Reconstruction During Laparoscopic Pancreatic Surgery: A Single Center's Experience

Abstract

Background In pancreatic cancer surgery, tumor violation of blood vessels is often considered a contraindication of surgery, especially laparoscopic surgery. We had completed 17 cases of major venous repair or reconstruction during laparoscopic pancreatic surgery, and we considered that this surgical method was safe and feasible based on the skilled laparoscopic techniques.Methods Between January 2014 and March 2022. A prospective cohort of 17 patients underwent major venous repair or reconstruction. Among them, 15 cases underwent laparoscopic pancreaticoduodenectomy (LPD), 1 case underwent laparoscopic distal pancreatectomy (LDP) and 1 case underwent laparoscopic central pancreatectomy (LCP). In all cases the pancreatic tumor invaded either portal veins (PV) or superior mesenteric veins (SMV). 13 cases underwent laparoscopic venous resection and reconstruction and 4 cases underwent venous repair.Results Of 17 patients, 10 (58.8%) were male. The mean age was 67.1 (ranged 57-81). All patients successfully completed the operation without transit to open. The average blocking time of venous resection and reconstruction was 30.1 (ranged 15-41) min and the average time of venous wedge resection and stitching was 24.0 (ranged 18-30) min. After surgery, there were no complications such as portal vein stenosis, bleeding, thrombosis and liver failure. 13 patients died within 2 years because of the tumor recurrence, and 4 patients are currently followed by outpatient visits, with no obvious signs of tumor recurrence.Conclusion Studies have shown that the reconstruction or repair of the major veins under laparoscopic surgery was safe and effective. We recommended that surgeons need to have the basics of open surgery in case laparoscopic surgery cannot be continued, and have pro cient laparoscopic surgery techniques combined with extensive training to achieve a learning curve for vascular anastomosis.

Comparison of laparoscopic versus open pancreaticoduodenectomy combined with portal vein/superior mesenteric vein resection and reconstruction for pancreatic cancer: a propensity score matching analysis

“…The procedure and feasibility of LPD with major vascular resection has been described in previously published studies at our center ( 19 ). This study used 1:1 PSM to control confounding factors, such as the vascular reconstruction method and clinical baseline data, the results indicated the advantages of less intraoperative bleeding in the LPD group, with postoperative complications and long-term prognosis similar to that of the OPD group.…”

“…In recent years, several institutions have reported minimally invasive surgery with major venous resection ( 19 , 23 , 24 ). Kendrick et al ( 25 ) first reported LPD combined with vascular resection and reconstruction, proved the feasibility of the technique, and proposed that with the help of a good field of view, magnification and positive intra-abdominal pressure, it might give outcomes superior to those of open surgery.…”

“…The portal vein and superior mesenteric vein were clamped with vascular clamps, the specimen was completely excised and continuous suture with 5-0 or 6-0 Prolene thread ( Figure 2C,2D ), as shown in Video 1 . The technique of vascular reconstruction has been described previously ( 19 ). Reconstruction of the digestive tract using duct-to-mucosa pancreaticojejunostomy, gastrojejunostomy and hepaticojejunostomy.…”