Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.
Background/aim: Pancreatic cancer is still associated with poor survival rates due to the fact that it is most often diagnosed at advanced stages of the disease when local invasion is present. However, improvements of surgical techniques have enabled extended resections with curative intent. We present the case of a 43-year-old patient diagnosed with locally invasive pancreatic adenocarcinoma invading the portal vein and the common hepatic artery. Case Report: Surgery with curative intent consisting of pancreatoduodenectomy en bloc with hepatic artery resection and portal vein resection was successfully performed. The right hepatic artery was further anastomosed with the remaining common hepatic artery while the left hepatic artery was reconstructed using a reversed splenic artery patch. The continuity of the portal vein was reestablished by placing a synthetic prosthesis. Conclusion: Combined arterial and venous resections might be useful in order to achieve a good local control of disease in patients with locally advanced pancreatic cancer.
Although the necessity of performing radical mastectomy has significantly decreased over the last decades there are still cases in which this procedure is required, predisposing the patient to the development of long-term complications such as upper limb lymphedema. Meanwhile, due to the increased implementation of indocyanine green usage, the rates of this complication have decreased, preservation of the lymphatic vessels of the arm being more and more possible. Even though, upper limb lymphedema can be still encountered, in such cases vascular surgical procedures such as lymphovenous anastomoses might be performed in order to treat this complication. This is a literature review regarding the usage and effectiveness of indocyanine green administration in the upper limb lymphedema treatment.
Ovarian cancer is frequently associated with upper abdominal involvement necessitating extensive resections at this level. In such cases a significant increase of the postoperative complications is to be expected, the most commonly encountered one being represented by pleural effusion. Another complication which is described less frequently but which is associated with higher risks is represented by upper abdominal herniation at the level of the thorax. The aim of this paper is to discuss the risk factors and the therapeutic strategies in such cases.
Lobular breast cancer represents a rare histopathological subtype of this malignancy, being characterized by a particular way of lymphatic spread. Therefore, the most widely known property of this tumor is the one of skipping certain lymphatic groups. Due to this aspect, the benefits of sentinel node identification were considered to be controversial so far. The aim of the current paper is to discuss about the indications and contraindication of this procedure in lobular carcinoma of the breast.
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