Splenic Vein–Inferior Mesenteric Vein Anastomosis to Lessen Left-Sided Portal Hypertension After Pancreaticoduodenectomy With Concomitant Vascular Resection

Ferreira, Nélio Reis

doi:10.1001/archsurg.2011.688

Cited by 47 publications

(34 citation statements)

References 34 publications

(53 reference statements)

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“…Some authors have described the importance of preservation of the SV/IMV confluence or SV/IMV anastomosis, and surgeons usually consider preserving the major branches, especially the IMV, when the SV requires transection. However, our results seem to contradict the concept that preservation of an IMV that flows into the remnant SV can avoid sinistral portal hypertension [14,16,32,33] . Although the blood in the remnant SV is believed to flow in an anterograde direction through the anastomosis or confluence into the IMV, the flow might proceed in the opposite direction in some patients, resulting in enhanced sinistral portal hypertension over the long term.…”

Section: Significance Of Splenic Vein Transectioncontrasting

confidence: 89%

“…The inferior mesenteric vein (IMV) drains directly into the SV in 51-68% of cases [14,19,20] , and it is postulated that the preservation of the IMV can maintain the venous drainage of the spleen and gastric remnant, obviating the need for SV reconstruction. Some authors have emphasized the efficacy and necessity of additional anastomosis of the SV/IMV [14,16] . However, the clinical significance of this anastomosis remains unclear because all such studies involved small cohorts (maximum of 39 cases) [16] .…”

Section: Significance Of the Splenic Vein And Its Branches In Pancreamentioning

confidence: 99%

“…Some authors have emphasized the efficacy and necessity of additional anastomosis of the SV/IMV [14,16] . However, the clinical significance of this anastomosis remains unclear because all such studies involved small cohorts (maximum of 39 cases) [16] .…”

Section: Significance Of the Splenic Vein And Its Branches In Pancreamentioning

confidence: 99%

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Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

et al. 2015

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Background/Aims: Pancreatic head carcinoma frequently invades the superior mesenteric vein (SMV) and/or portal vein (PV). We aimed to evaluate the outcome of transection of the splenic vein (SV) and inferior mesenteric vein (IMV) in pancreatoduodenectomy (PD) with SMV and/or PV resection. Methods: We retrospectively analyzed the records of 660 patients who had undergone pancreatectomy at our institution from January 2004 to October 2013, and selected 141 consecutive patients who had undergone PD with concurrent SMV/PV resection. Postoperative hypersplenism and the presence of remnant branches were evaluated. Results: The SV had been transected in 81 patients and preserved in 60. Postoperative complications and white blood cell counts were similar between the groups. The postoperative splenic volume was not significantly associated with the status of the SV or IMV on the transected SV. The platelet count was significantly lower, and the incidence of collateral veins was higher after SV transection than after SV preservation until 6 months after surgery; these variables were similar in the long term. Conclusion: SV reconstruction might be unnecessary when SV transection is required. Preservation of the IMV on the remnant SV might not prevent sinistral portal hypertension.

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Section: Significance Of Splenic Vein Transectioncontrasting

confidence: 89%

Section: Significance Of the Splenic Vein And Its Branches In Pancreamentioning

confidence: 99%

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Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

et al. 2015

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Section: Surgical Treatment: Recent Trends and Advancementsmentioning

confidence: 99%

“…Potential risks of ligating the splenic vein include left-sided portal hypertension, splenomegaly, esophageal varices and hypertensive gastropathy. If the SV-IMV confluence is absent or impossible to preserve, drainage of the SV may be reestablished by construction of an anastomosis between the SV and IMV to avoid left-sided portal hypertension [67].The ISGPS does not recommend arterial resection on a routine basis [59], as pancreatic resection with simultaneous arterial resection is associated with a greatly increased perioperative mortality (>5-times) and halved 1-year survival rate compared with similar patients without arterial resection [68]. However, arterial resection is associated with more favorable survival rates compared with patients who did not undergo resection for locally advanced disease.…”

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confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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Safety and Effectiveness of Splenic Vein to Inferior Mesenteric Vein Anastomosis During Pancreaticoduodenectomy

Arnaoutakis

Eckhäuser²

2011

Arch Surg

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Splenic Vein–Inferior Mesenteric Vein Anastomosis to Lessen Left-Sided Portal Hypertension After Pancreaticoduodenectomy With Concomitant Vascular Resection

Abstract: Hypothesis: A splenic vein (SV)-inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence but carries a risk of left-sided venous hypertension.

Cited by 47 publications

References 34 publications

Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

Pancreatic Cancer: Yesterday, Today and Tomorrow

Safety and Effectiveness of Splenic Vein to Inferior Mesenteric Vein Anastomosis During Pancreaticoduodenectomy

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