Radical pancreatectomy with superior mesenteric vein resection and reconstruction in patients with tumor located in uncinate process invading mesenteric root

Abstract

Pancreatic neoplasm may be deemed locally unresectable because they appear to encase the superior mesenteric vessels. A radical pancreatectomy with venous resection and reconstruction offer an important benefit in selected patients. At present, superior mesenteric vein /portal vein resection is performed in up to 25% of patients in our center. A variety of venous reconstruction have been described: Longitudinal or transverse venorrhaphy with a small ellipse vein excised or Segmental vein resection with or without splenic vein preservation. A primary end to end suture or interposition graft conduit (internal yugular vein or renal vein graft) can be performed to re-establish the venous continuity. For short segment resection (< 3 cm), primary end to end reconstruction and transverse venorrhaphies provide superior outcome to the other alternatives. For longer segmental resections, interposition grafting with an aprópiate size match achieve a greater long-term patency. The more important surgical challenge is always in tumors located in uncinate process with mesenteric root invasión. In these cases, after pancreatic and vascular resection, a patch venoplasty with 2, 3 or 4 native veins can be performed with or without interposition grafts. We discuss the different surgical steps used to restore vein continuity in patients with this complex tumor location.