[Reconstruction of visceral arteries with homografts in excision of the pancreas].
BACKGROUND
At present, surgical treatment with R(0) resection offers the only chance of cure for patients suffering from pancreatic cancer. Carcinomas of the pancreas are frequently diagnosed at an inoperable stage because of local tumor progression by vessel wall infiltration. In a small series of patients, efforts have been made to increase curative resection rates for advanced pancreatic cancer by excision and reconstruction of the involved visceral arteries. Whether this provides clinical benefit remains uncertain.


METHODS
Since 2001 we have been employing "en bloc" tumor resection for advanced pancreatic carcinomas with extended infiltration of visceral vessels. Technical experience was gained previously by performing portal vein resection as well as arterial excision and reconstruction by direct anastomosis in the presence of malignant wall infiltration. A total of ten patients underwent vascular reconstruction by arterial homograft interposition. In six of ten cases, combined extended reconstructions of the hepatic and superior mesenteric arteries were performed. One patient died during the perioperative course due to fulminant bleeding. One patient developed severe diarrhea. During a 3- to 18-month follow-up, one case of liver metastasis and one case of local tumor recurrence were documented.


CONCLUSIONS
In selective cases, operability and R(0) resection can be achieved in advanced pancreatic cancer by performing extended resection procedures with vascular reconstruction using arterial homografts. Vascular substitution of visceral arteries can be conducted without ischemic disturbances of the small bowel and liver. Only a few perioperative complications were observed.
Settmacher
U
U
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Virchow Klinikum, Charité, Humboldt-Universität, Berlin. utz.settmacher@charite.de
Langrehr
J M
JM
Husmann
I
I
Eisele
R
R
Bahra
M
M
Heise
M
M
Neuhaus
P
P
D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014670:Ampulla of Vater / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D000714:Anastomosis, Surgical; D001158:Arteries / Q000601:surgery / Q000637:transplantation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D003138:Common Bile Duct Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000075202:Contraindications; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008866:Microsurgery; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000098:blood supply* / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D014184:Transplantation, Homologous; D014781:Viscera / Q000098:blood supply*