Vascular reconstruction plays an important role in the treatment of pancreatic adenocarcinoma

Sgroi, Michael D.; Narayan, Raja R.; Lane, John S.; Demirjian, Aram N.; Kabutey, Nii-Kabu; Fujitani, Roy M.; Imagawa, David K.

doi:10.1016/j.jvs.2014.09.003

Cited by 56 publications

(35 citation statements)

References 27 publications

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“…Primary end-to-end anastomosis and venorrhaphy are reportedly used in 20-83% and 15-56% of patients, respectively. [4][5][6][7][8][9][10][11][12] When primary anastomosis is difficult to achieve due to tension and the ensuing risk of stenosis, different types of grafts can be used. Autologous grafts from the internal jugular vein, saphenous vein, superficial femoral vein, left renal vein or gonadal vein have been reported, either as patch or interposition grafts.…”

Section: Introductionmentioning

confidence: 99%

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Kleive

Berstad

Verbeke

et al. 2016

HPB

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Section: Introductionmentioning

confidence: 99%

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Kleive

Berstad

Verbeke

et al. 2016

HPB

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“…Sollte es zu einer Verletzung der größeren viszeralen Arterien kommen, sind die Erweiterung des Präparationsfelds zur Gefäßausklemmung zentral und distal der Verletzung (Blutungskontrolle!) nach systemischer oder intravasaler Gabe von unfraktioniertem Heparin zur Vermeidung von Appositionsthromben, die Darstellung der Verletzung und deren Versorgung je nach Ausmaß durch transversale Naht, Resektion des verletzten Segments mit spannungsfreier Reanastomosierung bei kurzen Segmenten oder Interposition von bestenfalls autologen, lumenkongruenten Gefäßen zu fordern [12,22]. Als in Notfallsituationen leicht erreichbare Interponate empfehlen sich in diesen Situationen die V. mesenterica inferior, V. lienalis, V. saphena magna oder die V. femoralis, sodass auch Kenntnisse und Fertigkeiten über deren Anatomie und verletzungsfreie Explantation als Transplantat zu fordern sind [11,23].…”

Section: Materials Und Methodenunclassified

Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie – was muss ein Viszeralchirurg können und wissen

et al. 2017

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Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon. However, skills in vascular surgery are still not obligatory for the visceral surgeon in training. This topic is controversial and is therefore the focus of the present study. From 2010 - 2015, a total of 126 patients underwent visceral operations involving vascular surgical interventions. Of these, 30 operations were performed as radical tumour resections. Retrospective data acquisition was performed with a minimum follow-up of 12 months. Aside from comprehensive characterisation of patients and their diseases, an outcome analysis was conducted. Furthermore, visceral surgery training programs in accordance with all 17 German federal medical associations were analysed and compared with respect to vascular surgery teaching. Vascular surgery was necessary in most patients, due to lesions of the mesentericoportal venous system (n = 11; 37%) and visceral arteries (n = 14; 47%). Techniques involved were mostly vascular sutures, reanastomosis or patch plastic surgery (n = 19; 63%) and venous thrombectomy/arterial embolectomy (n = 18; 60%). Hospital mortality was 3%. During follow-up, 33% of oncological patients died, whereas solely venous injury was an independent adverse prognostic variable (arterial vs. venous complications: HR 0.028; 95%-CI 0.002 - 0.442; p = 0.01). Skills in vascular surgery are optional for up to 12 months within visceral surgery training. Intraoperative vascular complications in visceral surgical oncology are rare but pose severe risks for the patients. Their management requires basic knowledge and skills in vascular anatomy, preparation and skills to ensure immediate safe control of bleeding, as well as suture techniques and interposition grafts. Current training and specialisation in visceral surgery does not include obligatory vascular surgery teaching, so that this issue needs reevaluation.

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“…In a meta-analysis, Mollberg and co-workers stated that pancreatectomies with arterial resections are associated with a poor short- and long-term outcome [3]. Recent data from literature, however, implies that the short-term outcome of arterial resections performed in expert hands is comparable to that of conventional pancreatectomies [4]. Other data shows that long-term results are better for isolated arterial resections only rather than combined arterial-venous ones [1].…”

Section: Introductionmentioning

confidence: 99%

Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy

Westermark

Rangelova

Ansorge

et al. 2016

Langenbecks Arch Surg

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BackgroundThe recent development of new neo-adjuvant treatment regimens associated with a higher success rate of down-staging has increased the interest of pancreatic surgeons on the role of extended surgery for patients affected by locally advanced pancreatic cancer. Pancreatectomy together with resection of the portal/superior mesenteric vein is considered nowadays standard of care for patients affected by pancreatic cancer. However, the resection of major abdominal arteries is still debatable. In particular, the short- and long-term results after resection of the superior mesenteric artery (SMA) remain controversial and only few cases have been described in literature. The present paper describes a new, quick, and easy technique for resection of the SMA.Clinical caseA 71-year-old patient affected by IPMN cancer with infiltration of the SMA received FOLFIRINOX-based neo-adjuvant treatment. After 4 months of treatment, the patient underwent total pancreatectomy with en bloc resection of the SMA and direct end-to-end anastomosis. The vascular resection was performed combining a complete Cattell-Braasch maneuver with local bowel hypothermia in an attempt to avoid graft interposition by facilitating an end-to-end anastomosis and to reduce the warm ischemia time. The post-operative course was uneventful and the patient was discharged 8 days post-operatively.

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Vascular reconstruction plays an important role in the treatment of pancreatic adenocarcinoma

Abstract: An aggressive approach for stage II pancreatic cancers with venous or arterial invasion can be performed with comparable results when it is executed by an experienced institution with skilled oncologic and vascular surgeons.

Cited by 56 publications

References 27 publications

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie – was muss ein Viszeralchirurg können und wissen

Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy

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