The role of vascular reconstructions in surgery of tumors of the hepatopancreatobiliary zone

Abstract

According to the point of view that has been dominating for many years, pancreatoduodenal resection was indicated only for localized tumors of the pancreas without involvement of the major vessels. In view of the prevalence of this pathology, many authors have recently pointed out the need to perform resection of a pancreatic tumor in a single bloc with the vessels involved, which gives a chance to increase the resectability in a larger number of patients.
 Aim. Analysis of resectability of pancreatic tumors on the basis of the data of current clinical research. In recent decades many different surgical approaches have been improved which increases chances for successful and safe surgical intervention. The data of the analysis of literature on vascular reconstructions in surgery for tumors of the hepatopancreatobiliary zone showed that resections and reconstructions of the mesenteric portal venous segment permit to increase resectability of tumor and should correspond to the fundamental principles of surgical oncology. To date, in terms of the incidence of postoperative complications and mortality, no statistically significant differences were found between the group of patients in whom vascular resection was performed, and the group with a standard pancreatoduodenal resection. A thorough preoperative selection of patients along with the correct strategy of venous reconstruction is equally important for correct and successful resection of the blood vessels en bloc.

Clinical and Variant Anatomy of the Blood Supply to the Body and Tail of the Human Pancreas

“…В патогенезе всех этих осложнений ведущее значение имеет нарушение артериального кровоснабжения поджелудочной железы [1,6,8]. Изучение артериального бассейна поджелудочной железы в настоящее время проводится достаточно активно и отечественными, и зарубежными анатомами, рентгенологами, хирургами [2,3,11,17]. Однако в подавляющем большинстве случаев внимание ученых сосредоточено на артериальной архитектонике головки поджелудочной железы и двенадцатиперстной кишки [12][13][14][15][16].…”