title: Superior mesenteric-portal vein resection during laparoscopic pancreatoduodenectomy.
abstract: Laparoscopic pancreatoduodenectomy (LPD) with concomitant resection of major portal vessels has recently emerged as feasible and safe, with similar morbidity and mortality as well as oncologic outcome compared with patients undergoing open PD with major vascular resection.
  
  
  
  Of a consecutive series of 133 LPD, eight patients underwent concomitant superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction with the intent of achieving a R0 resection.
  
  
  
  Four of these eight patients had tangential resection followed by lateral wall repair with Prolene 4.0. One patient had tangential resection with patch reconstruction. Three patients had circular venous resection: One had end-to-end primary venous reconstruction, and two patients had a prosthetic vascular graft interposition. There was no operative mortality. The SMV/PV was patent in all patients postoperatively on ultrasound Doppler or CT scans. Two patients (who underwent circular venous resection) had postoperative complications. One 77-year-old patient with preexisting cardiovascular disease died of heart failure on postoperative day 2, while another (undergoing prosthetic graft reconstruction) had postoperative bilioenteric anastomotic dehiscence and underwent immediate re-laparoscopy for repair.
  
  
  
  In our experience, LPD with concomitant major venous resection is feasible even in cases of longitudinal venous invasion. Further studies are needed to evaluate the role of laparoscopy in borderline pancreatic cancer.
authors.affiliation: Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.|Chair of Faculty Surgery №2, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Igor E
authors.initials: IE
authors.lastname: Khatkov
authors.affiliation: Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.|Chair of Faculty Surgery №2, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Roman E
authors.initials: RE
authors.lastname: Izrailov
authors.affiliation: Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia. a.khisamov@mknc.ru.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Khisamov
authors.affiliation: Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.|Chair of Faculty Surgery №2, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Pavel S
authors.initials: PS
authors.lastname: Tyutyunnik
authors.affiliation: Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Abraham
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Laparoscopic pancreatoduodenectomy; Portal vein; Resection; Superior mesenteric vein