title: Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: initial experience from the Medical College of Wisconsin.
abstract: BACKGROUND
  Vascular resection/reconstruction at the time of pancreatectomy is performed when limited vascular involvement is the only barrier to complete resection. Splenic vein (SV) ligation facilitates resection/reconstruction of the superior mesenteric vein (SMV)-portal vein (PV) confluence and widely exposes the superior mesenteric artery and celiac origin. If the inferior mesenteric vein does not provide for retrograde decompression, SV ligation may result in sinistral portal hypertension; creation of a distal splenorenal shunt (DSRS) can prevent this complication. Additional complexity occurs in the setting of cavernous transformation of the PV. A mesocaval shunt (MCS) can be utilized to temporarily divert portal flow allowing for a safe portal dissection. Herein we report our initial experience utilizing DSRS and MCS at the time of pancreatectomy for cancer.
  
  
  METHODS
  We reviewed all patients who underwent pancreatic resection for cancer and had either a DSRS and/or MCS performed between January 1, 2009 and February 1, 2012.
  
  
  RESULTS
  Of 11 patients identified, 10 had adenocarcinoma, 9 underwent standard or extended pancreaticoduodenectomy, and 2 underwent total pancreatectomy. Median operative time was 9.5 hours, median blood loss was 1,000 mL and median duration of stay was 10 days. There were no mortalities. There was 1 Clavien grade III complication during the index admission and 3 others were readmitted. No patient required reoperation.
  
  
  CONCLUSIONS
  We provide proof of concept that extended pancreatic resection in the setting of limited vascular involvement can be safely performed. This is the first report utilizing MCS and DSRS to facilitate resection of the SMV-PV confluence in the setting of cavernous transformation of the PV.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI 53226, USA. kchristi@mcw.edu
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Kevin
authors.initials: K
authors.lastname: Riggle
authors.forename: Rebecca
authors.initials: R
authors.lastname: Keim
authors.forename: Sam
authors.initials: S
authors.lastname: Pappas
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Paul
authors.initials: P
authors.lastname: Ritch
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery; D013164:Splenorenal Shunt, Surgical / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000601:surgery*