Splenic vein reconstruction is unnecessary in pancreatoduodenectomy combined with resection of the superior mesenteric vein–portal vein confluence according to short-term outcomes

Tanaka, Haruyoshi; Nakao, Akimasa; Oshima, Kenji; Iede, Kiyotsugu; Oshima, Yutaka; Kobayashi, Hironobu; Kimura, Yasunori

doi:10.1016/j.hpb.2017.02.438

Cited by 37 publications

(37 citation statements)

References 35 publications

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“…Some have considered reconstructing the SpV to prevent LPH. Although there have been reports that it is important to preserve the flow of the LGV and MCV directly into the PV-SMV when SpV reconstruction is unnecessary [1][2][3], it may not be possible when tumor invasion necessitates resection, as in this case. There is also a report that the simultaneous resection of the splenic artery can prevent the occurrence of varices due to LPH, but in this case, there was a risk of severe complications such as splenic infarction and residual gastric blood flow disorder [7].…”

Section: Discussionmentioning

confidence: 92%

“…In addition, there may be another route from the SpV to the SMV and/or PV via the IMV via the marginal vein of the left-sided or transverse colon and/or the right-sided colon, which may cause colonic varices [7]. In addition to these four routes, there are two non-varicose routes: splenic-colonic collateral circulation (arc of Barkow) and physiological splenic renal shunt [1]. Regarding the incidence of colonic varices, a previous study involving 43 cases that underwent PD with PVR reported that colonic varices developed in 27 cases (63%) and 3 cases required treatment [4].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatoduodenectomy (PD) with resection of the portal vein (PV) or superior mesenteric vein (SMV) confluence has been safely performed in patients with pancreatic head cancer associated with infiltration of the PV or SMV. There are reports demonstrating that splenic vein (SpV) reconstruction is unnecessary, but there is no consensus on this [1][2][3]. In recent years, left-sided portal hypertension (LPH), a late postoperative complication, has received focus owing to increased long-term survival with advances in chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

et al. 2020

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Background: Pancreatoduodenectomy with resection of the portal vein or superior mesenteric vein confluence has been safely performed in patients with pancreatic head cancer associated with infiltration of the portal vein or superior mesenteric vein. In recent years, left-sided portal hypertension, a late postoperative complication, has received focus owing to increased long-term survival with advances in chemotherapy. Left-sided hypertension may sometimes cause fatal gastrointestinal bleeding because of the rupture of gastrointestinal varices. Here, we present a case of colonic varices caused by left-sided portal hypertension after pancreatoduodenectomy with portal vein resection. Case presentation: A 69-year-old man diagnosed with pancreatic head cancer was referred to our department for surgery after undergoing chemotherapy with nine courses of gemcitabine and nab-paclitaxel. Computed tomography showed a mass 25 mm in diameter and in contact with the portal vein. He had undergone subtotal stomachpreserving pancreatoduodenectomy with portal vein resection. Four centimeters of the portal vein had been resected, and end-to-end anastomosis was performed without splenic vein reconstruction. We had to completely resect the right colic vein, accessary right colic vein, and middle colic vein due to tumor invasion. The pathological diagnosis was ypT3, ypN1a, ypM0, and ypStageIIB, and he was administered TS-1 as postoperative adjuvant chemotherapy. Seven months after therapeutic radical surgery, he presented with melena with progressive anemia. Computed tomography revealed transverse colonic varices. He was offered interventional radiology. Trans-splenic arterial splenic venography showed that transverse colonic varices had developed as collateral circulation of the splenic vein and inferior mesenteric vein system. An embolic substance was injected into the transverse colonic varices, which halted the progression of the anemia caused by melena. Fifteen months after therapeutic radical surgery, local recurrence of the tumor occurred; he died 28 months after the surgery. Conclusions: When subtotal stomach-preserving pancreatoduodenectomy with portal vein resection is performed without splenic vein reconstruction, colonic varices may result from left-sided portal hypertension. Interventional radiology is an effective treatment for gastrointestinal bleeding due to colonic varices, but it is important to be observant for colonic necrosis and new varices.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

et al. 2020

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“…The anatomy of the gastric drainage veins should be determined by preoperative computed tomography angiography and intraoperative inspection. The importance of preservation of the LGV or RGEV has been emphasized in previous reports. Preoperative or intraoperative planning for preservation of the gastric drainage veins is important when TP is performed.…”

Section: Discussionmentioning

confidence: 96%

Gastric venous congestion and bleeding in association with total pancreatectomy

Nakao

Yamada

Fujii

et al. 2017

J Hepato Biliary Pancreat

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BackgroundGastric venous congestion and bleeding in association with total pancreatectomy (TP) were evaluated.MethodsThirty‐eight patients of TP were retrospectively analyzed. TP was classified as TP with distal gastrectomy (TPDG), pylorus‐preserving TP (PPTP), subtotal stomach‐preserving TP (SSPTP), and TP with segmental duodenectomy (TPSD).ResultsPortal vein or superior mesenteric vein resection and reconstruction was performed in 24 patients (62.2%). Gastric bleeding occurred immediately after tumor resection in one of eight patients who underwent SSPTP, and urgent anastomosis between the right gastroepiploic and left ovarian vein stopped the bleeding. Another case of gastric bleeding was observed a few hours after TP in one of nine patients who underwent PPTP, and hemostasis was achieved after conservative therapy. Gastric bleeding was not observed in 16 patients who underwent TPDG and five who underwent TPSD. Some patients underwent preservation of gastric drainage veins (left gastric vein, right gastric vein, or right gastroepiploic vein). Neither patient with bleeding underwent preservation of a gastric drainage vein.ConclusionsTo preserve the subtotal or whole stomach when performing TP, one of the gastric drainage veins should undergo preservation or reconstruction, and anastomosis between the right gastroepiploic vein and left ovarian vein may be beneficial.

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“…Аналогичные результаты были получены в исследовании H. Tanaka и соавт. [15]. Профилактика послеоперационного панкреатита при резекционных операциях на ПЖ в первую очередь в случаях, сопряженных с резекцией вен, является обязательным компонентом периоперационного ведения больных.…”

Section: рис 3 кривая каплана-майера выживаемость больных после хиunclassified

Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion

Кригер

Kаrmаzаnovsky

Smirnov

et al. 2018

Khir. Z. im. N.I. Pirogova

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Злокачественные опухоли поджелудочной железы (ПЖ) представляют непростой диагностический объект и являются сложной задачей для хирургического лечения. У значительной части больных, на момент установления диагноза, отсутствует возможность радикального лечения (наличие отдаленных метастазов, обширное местное распространение), а у некоторых-возможность радикального удаления опухоли дискутабельна. Исходя из материалов, опубликованных в книге «Состояние онкологической помощи населению Рос

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Splenic vein reconstruction is unnecessary in pancreatoduodenectomy combined with resection of the superior mesenteric vein–portal vein confluence according to short-term outcomes

Abstract: SMPVrPD without SV reconstruction can be safely conducted. Additionally, preservation of these two confluences may reduce the risk of LSPH.

Cited by 37 publications

References 35 publications

Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

Colonic varices treated with embolization after pancreatoduodenectomy with portal vein resection: a case report

Gastric venous congestion and bleeding in association with total pancreatectomy

Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion

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