Portal vein reconstruction using an autologous splenic vein graft at the superior mesenteric and portal vein confluence during pancreaticoduodenectomy

Abstract

Introduction: Autologous vein graft reconstruction is needed in some cases following superior mesenteric portal vein (SMPV) resection during pancreatic cancer surgery. There have been no reports of reconstruction using a splenic vein autograft in a patient who underwent pancreaticoduodenectomy (PD). Methods: A 76-year-old woman was referred to our hospital for consultation based on a suspicion of pancreatic tumor. Computed tomography (CT) showed tumor in the uncinated process of the pancreas, approximately 40 x 30 mm in size, with narrowing of the superior mesenteric vein just below the SMPV confluence. Cytology of the pancreatic fluid revealed adenocarcinoma of the pancreas. She underwent PD and the mass was confirmed to have invaded the SMPV confluence. After clamping the splenic vein root with a vascular clamp, approximately 70 mm of the SMPV segment was resected. Then, the distal side of the pancreas with the splenic vein was raised and the splenic vein was dissected from the pancreas to harvest an autologous graft of the healthy splenic vein. Vascular reconstruction was performed using the 30-mm segment of the harvested splenic vein. The total time required for blocking and anastomosing the portal vein was 45 minutes. The final pathologic report revealed portal vein invasion, T4N0M0, and R0 resection. The patient received adjuvant chemotherapy. Follow-up CT at the 15th postoperative month showed a patent graft without evidence of recurrence. Conclusions: Splenic vein interposition grafting could be used in cases of PD with resection of the SMPV confluence, if the splenic vein is healthy.