title: Early vein reconstruction and right-to-left dissection for left-sided pancreatic tumors with portal vein occlusion.
abstract: Large left-sided pancreatic tumors are frequently associated with portal vein (PV) and/or superior mesenteric vein (SMV) occlusion. Traditionally, vein reconstruction is deferred until after removal of the tumor. However, division of venous collaterals, as is done in a typical left-to-right fashion, leads to progressive portal hypertension and increased risk of variceal hemorrhage during the dissection. Conversely, early PV/SMV resection and reconstruction restores mesenteric-portal flow and decompresses varices, thereby enabling a safer and easier right-to-left pancreatic resection. This "How I Do It" report describes the technique and advantages of a "reconstruction-first" approach for large left-sided pancreatic tumors with venous involvement and left-sided portal hypertension.
authors.affiliation: Department of Surgery, Stanford University, H368, 300 Pasteur Drive, Stanford, CA, 94305, USA, jcloyd@stanford.edu.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
mesh_terms: D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008102:Liver Circulation / Q000502:physiology; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D056888:Patient Positioning; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*
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