Vascular Resection in Pancreatectomy—Is It Safe and Useful for Patients with Advanced Pancreatic Cancer?

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with poor prognosis and increased incidence. Surgical resection R0 remains the most important treatment to prolong survival in PDAC patients. In borderline and locally advanced cancer, vascular resection and reconstruction during pancreatectomy enables achieving R0 resection. This study is a comprehensive review of the literature regarding the role of venous and arterial resection with vascular reconstruction in the treatment of pancreatic cancer. The literature review is focused on the use of venous and arterial resection with immediate vascular reconstruction in pancreaticoduodenectomy. Different types of venous and arterial resections are widely described. Different methods of vascular reconstructions, from primary vessel closure, through end-to-end vascular anastomosis, to interposition grafts with use autologous veins (internal jugular vein, saphenous vein, superficial femoral vein, external or internal iliac veins, inferior mesenteric vein, and left renal vein or gonadal vein), autologous substitute grafts constructed from various parts of parietal peritoneum including falciform ligament, cryopreserved and synthetic allografts. The most attention was given to the most common venous reconstructions, such as end-to-end anastomosis and interposition graft with the use of an autologous vein. Moreover, we presented mortality and morbidity rates as well as vascular patency and survival following pancreatectomy combined with vascular resection reported in cited articles.

Safety and Efficacy of Irreversible Electroporation in Locally Advanced Pancreatic Cancer: An Evaluation from a Surgeon’s Perspective

“…In order to evaluate the safety of IRE against LAPC, the PS and VR groups were introduced in this study. As is well-known, the VR group is considered to have a high but acceptable complication rate [ 22 ]. The rate of complications in the IRE group was not higher than in the VR group.…”

Evaluation of Open Surgical and Endovascular Treatment Options for Visceral Artery Erosions after Pancreatitis and Pancreatic Surgery

“…The destruction of the elastase in the arterial wall by proteolytic enzymes or direct erosion of the vessel by a pseudocyst, pancreatic necrosis, or abscess may be the most common mechanisms of the bleeding [6,7]. Additionally, many factors such as local tissue injury and systemic inflammatory responses might be involved in microvascular injury in acute necrotizing pancreatitis leading to erosion bleeding [24][25][26]. Although microvascular pathomechanisms seem to be rather understood, causes for macrovascular complications such as erosion bleeding are not fully understood.…”

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection

“…They include: primary venous closure; end-to-end anastomosis; interposition grafts using autologous veins; autologous substitute grafts constructed from various parts of parietal peritoneum, including the falciform ligament; and cryopreserved and synthetic allografts. 25 The International Study Group for Pancreatic Surgery (ISGPS) proposed four types of SMV-PV resection: Type 1, tangential resections with venorrhaphy; Type 2, resections with patch reconstruction; Type 3, resection with end-to-end anastomosis; and Type 4, resections with graft interposition. 26 The optimal method for venous reconstruction after segmental SMV-PV resection remains a matter of debate.…”