Portomesenteric reconstruction during Whipple procedures: review and report of a case.
A 60-year-old man undergoing a Whipple procedure to treat a pancreatic cancer was found to have tumor adherence to the portal vein. An en block pancreaticoduodenectomy with segmental portal vein resection (PVR) was performed. A primary portal vein anastomosis was initially attempted but failed. Hemodynamic deterioration led the authors to perform a temporary prosthetic portal vein interposition graft and abdominal closure. The following morning, once stable, the patient was brought back to the operating room for autologous reconstruction with femoral vein and completion of the pancreaticoduodenectomy. The role of PVR for vein invasion or tumor adherence during a Whipple procedure is still under debate. However, there is growing evidence that the perioperative morbidity and long-term survival in patients who undergo a pancreaticoduodenectomy with PVR are similar to those of patients without vein resection. Therefore a combined resection of the pancreatic head and the portal vein has been suggested in the absence of other contraindications for resection to be able to offer a curative surgical intervention to a larger number of patients. The authors herein report the details of a patient's case and also review the currently available methods for PVR and reconstruction.
Leon
Luis R
LR
Southern Arizona Veterans Affairs Health Care System, University of Arizona Health Science Center Tucson, Arizona 85723, USA. luis.leon@va.gov
Hughes
John D
JD
Psalms
Shemuel B
SB
Guerra
Robert
R
Biswas
Atanu
A
Prasad
Anil
A
Krouse
Robert S
RS
D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005268:Femoral Vein / Q000637:transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures