Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 1994 Oct;168(4):352-4
Date
10/01/1994Pubmed ID
7943594DOI
10.1016/s0002-9610(05)80164-3Scopus ID
2-s2.0-0027971715 (requires institutional sign-in at Scopus site) 88 CitationsAbstract
Most surgeons believe that tumor invasion of the superior mesenteric-portal venous (SMPV) confluence is a contraindication to pancreaticoduodenectomy for adenocarcinoma of the pancreas or periampullary region. Traditional techniques for performing pancreaticoduodenectomy have emphasized the importance of establishing a tumor-free plane between the SMPV confluence and the neck of the pancreas. However, this maneuver does not reveal tumor invasion of the lateral wall of the superior mesenteric vein (SMV) until after gastric and pancreatic transection--a point at which the surgeon has committed to resection. This unexpected but not uncommon finding likely contributes to the high incidence of margin-positive resections and subsequent local tumor recurrence. We describe our technique for segmental resection of the SMPV confluence at the time of pancreaticoduodenectomy. Routine ligation of the splenic vein and primary anastomosis of the SMV and portal vein have been abandoned in favor of an interposition graft using internal jugular vein.
Author List
Cusack JC Jr, Fuhrman GM, Lee JE, Evans DBAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenocarcinomaAnastomosis, Surgical
Humans
Intraoperative Care
Jugular Veins
Ligation
Mesenteric Veins
Neoplasm Invasiveness
Pancreatic Neoplasms
Pancreaticoduodenectomy
Portal Vein
Soft Tissue Neoplasms
Suture Techniques
Vascular Diseases
