Faculty Collaboration Database

Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: initial experience from the Medical College of Wisconsin. Surgery 2013 Jul;154(1):123-31

Date

01/12/2013

Pubmed ID

23305596

DOI

10.1016/j.surg.2012.11.019

Scopus ID

2-s2.0-84882828441 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

BACKGROUND: Vascular resection/reconstruction at the time of pancreatectomy is performed when limited vascular involvement is the only barrier to complete resection. Splenic vein (SV) ligation facilitates resection/reconstruction of the superior mesenteric vein (SMV)-portal vein (PV) confluence and widely exposes the superior mesenteric artery and celiac origin. If the inferior mesenteric vein does not provide for retrograde decompression, SV ligation may result in sinistral portal hypertension; creation of a distal splenorenal shunt (DSRS) can prevent this complication. Additional complexity occurs in the setting of cavernous transformation of the PV. A mesocaval shunt (MCS) can be utilized to temporarily divert portal flow allowing for a safe portal dissection. Herein we report our initial experience utilizing DSRS and MCS at the time of pancreatectomy for cancer.

METHODS: We reviewed all patients who underwent pancreatic resection for cancer and had either a DSRS and/or MCS performed between January 1, 2009 and February 1, 2012.

RESULTS: Of 11 patients identified, 10 had adenocarcinoma, 9 underwent standard or extended pancreaticoduodenectomy, and 2 underwent total pancreatectomy. Median operative time was 9.5 hours, median blood loss was 1,000 mL and median duration of stay was 10 days. There were no mortalities. There was 1 Clavien grade III complication during the index admission and 3 others were readmitted. No patient required reoperation.

CONCLUSION: We provide proof of concept that extended pancreatic resection in the setting of limited vascular involvement can be safely performed. This is the first report utilizing MCS and DSRS to facilitate resection of the SMV-PV confluence in the setting of cavernous transformation of the PV.

Author List

Christians KK, Riggle K, Keim R, Pappas S, Tsai S, Ritch P, Erickson B, Evans DB

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Humans
Mesenteric Veins
Middle Aged
Pancreatectomy
Pancreatic Neoplasms
Splenic Vein
Splenorenal Shunt, Surgical
Tomography, X-Ray Computed
Vena Cava, Inferior