title: [Vascular resection and reconstruction techniques in pancreatic surgery].
abstract: BACKGROUND
  Vascular resection interventions and the associated necessity of a reconstruction for maintenance particularly of hepatic and small intestinal perfusion are important aspects especially for the surgical treatment of pancreatic cancer. An R0 resection is the only curative treatment option for patients with pancreatic cancer. Venous or arterial vascular infiltration by the tumor and the associated resection and reconstruction for complete tumor removal and establishment of a sufficient perfusion of the dependent organs represents one of the greatest challenges in pancreatic surgery. In addition the oncological significance with respect to arterial vascular resections is controversial.
  
  
  OBJECTIVE
  In this review article the indications and technical aspects of vascular resection and reconstruction in the therapy of pancreatic cancer are presented and discussed based on the current literature.
  
  
  METHODS
  A systematic search of Medline, Embase and the Cochrane Library was carried out to identify studies reporting the results of venous or arterial vascular resection techniques, postoperative morbidity, mortality and patient survival after surgery for pancreatic cancer. Results Pancreatic cancer with vascular infiltration should not principally be seen as non-resectable but must always be checked for the possibility of a curative resection. A decisive factor is the differentiation between venous and arterial vascular involvement. Various safe technical options are available for venous vascular resection, depending on the extent of tumor infiltration. Arterial vascular resections are associated with an increased morbidity and mortality. In selected patients a complete tumor resection and prolonged survival can be achieved by arterial vascular resection.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Klose
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Hackert
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Alexis.Ulrich@med.uni-heidelberg.de.
authors.forename: A
authors.initials: A
authors.lastname: Ulrich
mesh_terms: D001158:Arteries / Q000473:pathology / Q000601:surgery; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000098:blood supply* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000379:methods*; D014680:Veins / Q000473:pathology / Q000601:surgery
keywords: Pancreatic cancer; Surgery; Survival; Vascular reconstruction; Vascular resection