title: Resection of tumors of the neck of the pancreas with venous invasion: the "Whipple at the Splenic Artery (WATSA)" procedure.
abstract: BACKGROUND
  Tumors of the neck of the pancreas may involve the superior mesenteric and portal veins as well as the termination of the splenic vein. This presents a difficult problem since the pancreas cannot be transected through the neck as is standard in a Whipple procedure. Here, we present our method of resecting such tumors, which we term "Whipple at the Splenic Artery (WATSA)".
  
  
  METHODS
  The superior mesenteric and portal veins are isolated below and above the pancreas, respectively. The pancreas and splenic vein are divided just to the right of the point that the splenic artery contacts the superior border of the pancreas. This plane of transection is approximately 2 cm to the left of the pancreatic neck and away from the tumor. The superior mesenteric artery is cleared from the left side of the patient. With the specimen remaining attached only by the superior mesenteric and portal veins, these structures are clamped and divided. Reconstruction is performed with or without a superficial femoral vein graft. The splenic vein is not reconstructed.
  
  
  RESULTS
  Ten cases have been performed to date without mortality. We have previously shown that the pattern of venous collateral development following occlusion of the termination of the splenic vein in the manner described is not similar to that of cases of sinistral (left sided) portal hypertension.
  
  
  CONCLUSIONS
  Whipple at the splenic artery (WATSA) is a safe method for resection of tumors of the neck of the pancreas with vein involvement. It should be performed in high-volume pancreatic surgery centers.
authors.affiliation: HPB Surgery Section, Department of Surgery, Washington University in Saint Louis, 660 South Euclid Avenue, Box 8109, Saint Louis, MO 63110, USA. strasbergs@wustl.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Luis A
authors.initials: LA
authors.lastname: Sanchez
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D010179:Pancreas / Q000033:anatomy & histology / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000601:surgery; D018570:Risk Assessment; D012494:Sampling Studies; D013157:Splenic Artery / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*