Cavernous transformation of the portal vein in pancreatic cancer surgery-venous bypass graft first.

Published on Sep 11, 2020in Langenbeck's Archives of Surgery3.445
· DOI :10.1007/S00423-020-01974-0
Thomas Schmidt34
Estimated H-index: 34
(Heidelberg University),
Oliver Strobel53
Estimated H-index: 53
(Heidelberg University)
+ 7 AuthorsMarkus W. Büchler177
Estimated H-index: 177
(Heidelberg University)
Sources
Abstract
Background In recent years, several techniques have been introduced to allow safe oncologic resections of cancers of the pancreatic head. While resections of the mesenterico-portal axis became now a part of the routine treatment, patients with a cavernous transformation of the portal vein still pose a surgical challenge and are regularly deemed unresectable. Objective Here, we describe a technique of initial venous bypass graft placement between the superior mesenteric vein or its tributaries and the portal vein before the resection of the pancreatic head. This approach avoids uncontrollable bleeding as well as venous congestion of the intestine with a continuous hepatic perfusion and facilitates oncologic resection of pancreatic head cancers. This technique, in combination with previously published resection strategies, enables tumor resection in locally advanced pancreatic head cancers. Conclusions Venous bypass graft first operations facilitate and enable the resection of the pancreatic head cancers in patients with a cavernous transformation of the portal vein thus rendering these patients resectable.
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Newest
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#2Thilo Hackert (Heidelberg University)H-Index: 57
Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis, mainly because only 15–20% of all patients present with resectable tumor stages at the time of diagnosis. Due to locally extended tumor growth or distant metastases upfront resection is not reasonable in the majority of patients. Considerably, PDAC will be the 2nd most frequent cause of cancer-related deaths within the next 10 years for both men and women. While there is currently no convincing evidence for the use of neoadjuv...
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#2Oliver Strobel (Heidelberg University)H-Index: 53
Last. Markus W. Büchler (Heidelberg University)H-Index: 177
view all 4 authors...
Background Pancreatic cancer is associated with high recurrence rates, and any surgery should aim to prevent local recurrence. However, systematic resection of putatively tumor-infiltrated soft tissue adjacent to the celiac branches and superior mesenteric artery has not regularly been applied in pancreatic head resection.
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#2Marius Distler (TUD: Dresden University of Technology)H-Index: 20
Last. Thilo Welsch (TUD: Dresden University of Technology)H-Index: 12
view all 6 authors...
Purpose Patients with borderline resectable pancreatic cancer are increasingly explored after neoadjuvant treatment protocols. A complete resection, then, frequently includes the resection of the mesentericoportal axis. Portosystemic shunting for advanced tumours with infiltration of the splenic vein or cavernous transformation of the portal vein can enable complete tumour resection and prevent portovenous congestion of the intestine. The aim of this study was to report the results of this techn...
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#1Hiroshi Kurahara (Kadai: Kagoshima University)H-Index: 27
#2Hiroyuki Shinchi (Kadai: Kagoshima University)H-Index: 32
Last. Masafumi Nakamura (Kyushu University)H-Index: 64
view all 22 authors...
Purpose Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study.
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Introduction Patients with locally advanced pancreatic cancer (LAPC) represent a challenging group to treat, given the involvement of major vascular structures. In selected patients with favorable biology, temporary mesocaval shunt can facilitate the resection and allow for a safer procedure with enhanced exposure to the superior mesenteric vessels.
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#2John P. Neoptolemos (University Hospital Heidelberg)H-Index: 127
Last. Markus W. Büchler (University Hospital Heidelberg)H-Index: 177
view all 4 authors...
Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10–20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with re...
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#2Carl-Stephan Leonhardt (Heidelberg University)H-Index: 1
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Background Only 15–20% of patients with pancreatic ductal adenocarcinoma (PDAC) have a resectable tumor at the time of diagnosis. Effective multimodal treatment concepts including neoadjuvant chemotherapy are therefore needed. Following upfront resection, adjuvant chemotherapy has become mandatory to prevent early tumor recurrence.
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#1Thomas Hank (University Hospital Heidelberg)H-Index: 11
#2Ulf Hinz (University Hospital Heidelberg)H-Index: 19
Last. Oliver Strobel (University Hospital Heidelberg)H-Index: 53
view all 9 authors...
BACKGROUND: The definition of resection margin (R) status in pancreatic cancer is under debate. Although a margin of at least 1 mm is an independent predictor of survival after resection for pancreatic head cancer, its relevance to pancreatic body and tail cancers remains unclear. This study aimed to validate R status based on a 1-mm tumour-free margin as a prognostic factor for resected adenocarcinoma involving the pancreatic body and tail. METHODS: Patients who underwent distal or total pancre...
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Cited By4
Newest
#1Mohammed Al-Saeedi (University Hospital Heidelberg)H-Index: 10
#2Leonie Frank-Moldzio (University Hospital Heidelberg)
Last. Arianeb Mehrabi (University Hospital Heidelberg)H-Index: 40
view all 13 authors...
Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. This study describes the surgical technique, postoperative course, and surgical outcomes of SRS afte...
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#1Martin Schneider (Heidelberg University)H-Index: 26
#2T. Hackert (Heidelberg University)H-Index: 17
Last. M.W. Büchler (Heidelberg University)H-Index: 79
view all 4 authors...
BACKGROUND Multimodal treatment concepts enhance options for surgery in locally advanced pancreatic ductal adenocarcinoma (PDAC). This review provides an overview of technical advances to facilitate curative-intent resection in PDAC. METHODS A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized. RESULTS Artery-first and uncinate-first approaches, dissection of the anatomical triangle between...
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#1Markus K. Diener (Heidelberg University)H-Index: 51
#2André L. Mihaljevic (Heidelberg University)H-Index: 21
Last. Markus W. Büchler (Heidelberg University)H-Index: 177
view all 14 authors...
Abstract Background Modern pancreatic cancer surgery changed with the introduction of effective neoadjuvant therapies. Complete tumor resection is the mainstay for long-term, disease-free, and overall survival and has been a prerequisite for decreasing local recurrence. The medial resection margin in the area of the superior mesenteric vessels limits the radicalness of the resection, especially in borderline and locally advanced cases. Therefore, the periarterial soft tissue around the peripancr...
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Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor of the digestive system with still low five-year survival of less than 10%. Although there are improvements for multimodal therapy of PDAC, surgery still remains the effective way to treat the disease. Combined with adjuvant and/or neoadjuvant treatment, pancreatic surgery is able to enhance the five-year survival up to around 20%. However, pancreatic resection is always associated with a high risk of complications and regard...
Source
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