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Superior mesenteric–portal vein resection during laparoscopic pancreatoduodenectomy

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Abstract

Background

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.

Materials and methods

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.

Results

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.

Conclusions

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.

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Abbreviations

CVC:

Central venous catheter

IPMN:

Intraductal papillary mucinous neoplasm

PD:

Pancreatoduodenectomy

OPD:

Open pancreatoduodenectomy

LPD:

Laparoscopic pancreatoduodenectomy

PV:

Portal vein

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

SV:

Splenic vein

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Author information

Authors and Affiliations

  1. Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia

    Igor E. Khatkov, Roman E. Izrailov, Arthur A. Khisamov & Pavel S. Tyutyunnik

  2. Chair of Faculty Surgery №2, Moscow State University of Medicine and Dentistry, Moscow, Russia

    Igor E. Khatkov, Roman E. Izrailov & Pavel S. Tyutyunnik

  3. Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria

    Abraham Fingerhut

Authors
  1. Igor E. Khatkov
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  2. Roman E. Izrailov
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  3. Arthur A. Khisamov
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  4. Pavel S. Tyutyunnik
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  5. Abraham Fingerhut
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Corresponding author

Correspondence to Arthur A. Khisamov.

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Disclosures

Igor E. Khatkov, Roman E. Izrailov, Arthur A. Khisamov, Pavel S. Tyutyunnik, and Abraham Fingerhut have no conflicts of interest.

Additional information

This article describes the technique of superior mesenteric/portal vein resection during laparoscopic pancreatectomies. It also contains the results and details of procedures with concomitant major venous resections that were successfully performed at the institution

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Khatkov, I.E., Izrailov, R.E., Khisamov, A.A. et al. Superior mesenteric–portal vein resection during laparoscopic pancreatoduodenectomy. Surg Endosc 31, 1488–1495 (2017). https://doi.org/10.1007/s00464-016-5115-3

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  • DOI: https://doi.org/10.1007/s00464-016-5115-3

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