Radical pancreatic resection combined with vascular resection and reconstruction: a report of 12 cases
Objective: To investigate the feasibility, indications and intraoperative precautions of radical surgery with vascular resection and reconstruction for pancreatic cancer with vascular invasion. Methods: The clinical data of 12 patients with pancreatic cancer invading the portal vein (PV)/superior mesenteric vein (SMV) undergoing radical surgery from March 2014 to December 2015 were retrospectively analyzed. Ten patients underwent pancreaticoduodenectomy, and of them synchronously, 3 cases had PV resection, one case had SMV resection, and 6 cases had PV plus SMV resection with splenic vein ligation without reconstruction, of whom, 5 cases had spleen preservation and one case had splenectomy due to severe splenic congestion; two patients underwent resection of the body and tail of the pancreas, and both cases had synchronous PV plus SMV resection and splenectomy. Portal vein occlusion time ranged from 16 to 30 min; end to end vascular anastomosis was performed in 10 cases and vascular prosthesis was used in 2 cases. Results: All 12 patients recovered uneventfully, and no perioperative death or complications such as biliary fistula, pancreatic fistula, bleeding, thrombosis, prosthetic graft infection and liver function failure occurred, and no manifestations of regional portal hypertension were found in the short-term after operation. Conclusion: Pancreaticoduodenectomy or resection of the body and tail of the pancreas in combination with vascular resection is feasible for selected cases in qualified hospital, and can increase the resectability rate, improve patients’ quality of life, with no increase in operative mortality and incidence of complications. However, it requires careful intraoperative anatomic dissection and meticulous operation as well as achievement of radical resection visible to the naked eye, for improving the safety of the operation and long-term survival rates.