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Langenbeck's Archives of Surgery

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01-12-2019 | Pancreatoduodenostomy | Original Article

Results of portosystemic shunts during extended pancreatic resections

Authors: Florian Oehme, Marius Distler, Benjamin Müssle, Christoph Kahlert, Jürgen Weitz, Thilo Welsch

Published in: Langenbeck's Archives of Surgery | Issue 8/2019

Abstract

Purpose

Patients with borderline resectable pancreatic cancer are increasingly explored after neoadjuvant treatment protocols. A complete resection, then, frequently includes the resection of the mesentericoportal axis. Portosystemic shunting for advanced tumours with infiltration of the splenic vein or cavernous transformation of the portal vein can enable complete tumour resection and prevent portovenous congestion of the intestine. The aim of this study was to report the results of this technique for selected patients.

Methods

Patients operated for pancreatic cancer at our department between September 2012 and December 2017 using intraoperative portosystemic shunting were included in this retrospective analysis.

Results

Some 11 patients with pancreatectomy and simultaneous portosystemic shunting were included. The median age was 65.1 years. A distal splenorenal shunt and a temporary mesocaval shunt were accomplished in 5 and 4 cases, respectively. Two patients were operated using persistent mesocaval shunts (from the coronary, splenic or inferior mesenteric veins). The median operating time was 9.43 h. All but one patient were resected with tumour-negative resection margins; 5 patients had relevant complicated postoperative courses. There was one case of in-hospital mortality but no further 30- or 90-day mortality or graft-associated complications. Five patients were alive after a median follow-up of 24.6 months. The median postoperative survival was 12 months.

Conclusion

Portosystemic shunting at the time of extended pancreatectomy is technically challenging but feasible and enables complete tumour resection in cases in which standard vascular reconstruction is limited by cavernous transformation or to prevent sinistral portal hypertension with acceptable morbidity in selected cases. Considering the limited overall survival, the potential individual patient benefit needs to be weighed against the considerable morbidity of advanced tumour resections.

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Title: Results of portosystemic shunts during extended pancreatic resections
Authors: Florian Oehme
Marius Distler
Benjamin Müssle
Christoph Kahlert
Jürgen Weitz
Thilo Welsch
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatoduodenostomy
Pancreatectomy
Pancreatoduodenostomy
Pancreatic Cancer
Pancreatic Cancer
Published in: Langenbeck's Archives of Surgery / Issue 8/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01816-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Results of portosystemic shunts during extended pancreatic resections

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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