Abstract
BackgroundResection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications.PurposeThis study describes the surgical technique, postoperative course, and surgical outcomes of SRS after pancreatoduodenectomy.MethodsTen patients who underwent pancreatoduodenectomy and SRS between September 2017 and April 2019 were evaluated. After resection an end-to-side anastomosis between the splenic vein and the left renal vein was performed. Postoperative shunt patency, splenic volume, and any SRS-related complications were recorded.ResultsThe rates of short- and long-term shunt patency were 100% and 60%, respectively. No procedure-associated complications were observed. No signs of left-sided portal hypertension, such as gastrointestinal bleeding or splenomegaly, and no gastric/splenic ischemia were observed in patients after SRS.ConclusionSRS is a safe and effective measure to mitigate gastric congestion and left-sided portal hypertension after pancreatoduodenectomy with compromised gastric venous drainage after resection of the portal venous confluence.
Highlights
Pancreatic cancer is characterized by poor prognosis due to late diagnosis and aggressive biology with early local invasion and high potential for systemic metastasis [1].Radical and high-quality surgical resection in combination with systemic chemotherapy remains the only curative treatment option for this aggressive disease
When the splenic vein (SV) is ligated during pancreatoduodenectomy with resection of the portal venous confluence, venous blood from the stomach and spleen can frequently drain via collateral veins including the left gastric vein dependent on venous anatomy
Most patients presented with pancreatic ductal adenocarcinoma (90%), while one patient had a neuroendocrine tumor
Summary
Pancreatic cancer is characterized by poor prognosis due to late diagnosis and aggressive biology with early local invasion and high potential for systemic metastasis [1].Radical and high-quality surgical resection in combination with systemic chemotherapy remains the only curative treatment option for this aggressive disease. When the SV is ligated during pancreatoduodenectomy with resection of the portal venous confluence, venous blood from the stomach and spleen can frequently drain via collateral veins including the left gastric vein ( called coronary vein) dependent on venous anatomy. Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. Ligation of the splenic vein can cause serious postoperative complications such as gastric/ splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. No signs of left-sided portal hypertension, such as gastrointestinal bleeding or splenomegaly, and no gastric/splenic ischemia were observed in patients after SRS. Conclusion SRS is a safe and effective measure to mitigate gastric congestion and left-sided portal hypertension after pancreatoduodenectomy with compromised gastric venous drainage after resection of the portal venous confluence
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