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Open Access 01-11-2020 | Pancreatic Cancer | How-I-Do-It articles

Cavernous transformation of the portal vein in pancreatic cancer surgery—venous bypass graft first

Authors: Thomas Schmidt, Oliver Strobel, Martin Schneider, Markus K. Diener, Christoph Berchtold, André L. Mihaljevic, Arianeb Mehrabi, Beat P. Müller-Stich, Thilo Hackert, Markus W. Büchler

Published in: Langenbeck's Archives of Surgery | Issue 7/2020

Abstract

Background

In recent years, several techniques have been introduced to allow safe oncologic resections of cancers of the pancreatic head. While resections of the mesenterico-portal axis became now a part of the routine treatment, patients with a cavernous transformation of the portal vein still pose a surgical challenge and are regularly deemed unresectable.

Objective

Here, we describe a technique of initial venous bypass graft placement between the superior mesenteric vein or its tributaries and the portal vein before the resection of the pancreatic head. This approach avoids uncontrollable bleeding as well as venous congestion of the intestine with a continuous hepatic perfusion and facilitates oncologic resection of pancreatic head cancers. This technique, in combination with previously published resection strategies, enables tumor resection in locally advanced pancreatic head cancers.

Conclusions

Venous bypass graft first operations facilitate and enable the resection of the pancreatic head cancers in patients with a cavernous transformation of the portal vein thus rendering these patients resectable.

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Title: Cavernous transformation of the portal vein in pancreatic cancer surgery—venous bypass graft first
Authors: Thomas Schmidt
Oliver Strobel
Martin Schneider
Markus K. Diener
Christoph Berchtold
André L. Mihaljevic
Arianeb Mehrabi
Beat P. Müller-Stich
Thilo Hackert
Markus W. Büchler
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatic Cancer
Pancreatic Cancer
Portal Hypertension
Portal Hypertension
Published in: Langenbeck's Archives of Surgery / Issue 7/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01974-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cavernous transformation of the portal vein in pancreatic cancer surgery—venous bypass graft first

Abstract

Background

Objective

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Conclusions

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