Venous Resection in Pancreatic Cancer Surgery

Abstract

Because of their anatomical proximity to the pancreatic head, the portal vein (PV) and superior mesenteric vein (SMV) are frequently involved in pancreatic head cancers. PV/SMV resection and reconstruction should be arranged according to the degree of PV/SMV invasion. In case of minimal invasion, the PV/SMV wall can be partially resected and repaired with direct suture, or a patch repair using a vein graft can be performed. In case of wide invasion of the lateral aspect of the vein or circumferential involvement, segmental resection of the PV/SMV should be performed. Reconstruction in this case will be performed using either direct end-to-end anastomosis or the interposition of vein graft. When the confluence of the splenic vein (SV) is involved and ligation and division of the SV is performed, varices caused by left-sided portal hypertension may form in the late phase after surgery. In such cases, preservation of the omentum and the transverse and right colic marginal vein is important to maintain the collateral route and to avoid the formation of varices. Several reports have indicated that pancreatectomy with PV/SMV resection can be performed with acceptable morbidity and mortality. Moreover, survival is comparable for patients with and without PV/SMV resection, although some reports indicate that the prognosis in patients with PV/SMV resection is worse than that of patients who do not undergo PV/SMV resection. The clinical benefit of PV/SMV resection for pancreatic cancer is still controversial.