Pancreatoduodenectomy with Venous Reconstruction

Abstract

Even in the ear of neoadjuvant therapy being in the spotlight, surgical resection still remains the only hope for cure of pancreatic cancer, while other treatment options were considered with the surgery as the mainstay. The most important goal of surgery was to achieve an R0 resection because R0 resection can provide unique benefit to patient. En bloc resection with combined vessels is an important technique to achieve an R0 resection and could attain reportedly an R0 resection rate of over 90% [1]. Due to the close proximity to venous axis, adenocarcinoma of the pancreatic head is easily with infiltration of portal vein (PV) and superior mesenteric vein (SMV). Therefore, it is inevitable for pancreatic surgeons to encounter PV and SMV resection and reconstruction (during the resection of pancreatic cancer), which was challenging decades ago. In 1951, Moore et al. [2] reported the first case of a pancreatoduodenectomy (PD) with superior mesenteric vein resection and reconstruction. In 1973, Fortner [3] reported the first case of a “regional pancreatectomy” involving portal vein resection. However, these procedures were later abandoned due to the high morbidity and mortality in the first decades after their introduction, with the improvement of surgical techniques, vascular suture material and critical care support, the morbidity, mortality, and survival outcome after PD are comparable in patients with and without venous resection.