Pancreatectomy With En Bloc Superior Mesenteric Vein And All Its Tributaries Resection Without PV/SMV Reconstruction For “Low” Locally Advanced Pancreatic Cancer

VIACHESLAV EGOROV; Pavel Kim; Soslan Dzigasov; Eugeny Kondratiev; Alexander Sorokin; Alexey Kolygin; Mikhail Vyborniy; Grigoriy Bolshakov; Pavel Popov; Anna Demchenkova; Tatiana Dakhtler

doi:10.20944/preprints202405.1209.v1

Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 17 May 2024 / Approved: 18 May 2024 / Online: 20 May 2024 (07:05:54 CEST)

Introduction. “Vein definition” for locally advanced pancreatic ductal adenocarcinoma (LA PDAC) assumes portal-to-superior mesenteric vein (PV/SMV) unreconstructability due to tumor involvement or occlusion. Radical pancreatectomies with SMV resection without PV/SMV reconstruction are scarcely discussed in the literature. Retrospective analysis of 19 radical pancreatectomies for “low” LA PDAC with SMV and all its tributaries resection without PV/SMV reconstruction has shown zero mortality, overall morbidity – 56%, Dindo-Clavien – 3-10,5%, R0- rate – 82%, mean operative procedure time – 355±154 min, mean blood loss – 330±170 ml, delayed gastric emptying– 25%, clinically relevant postoperative pancreatic fistula – 8%. In three cases surgery was associated with superior mesenteric (n2) and common hepatic artery (n1) resection. Surgery was completed without vein reconstruction (n13) and with inferior mesenteric-to-splenic anastomosis (n6). There were no cases of liver, gastric, or intestinal ischemia. A specific complication of the SMV resection without reconstruction was 2-3 days-long intestinal edema (48%). Median overall survival – 25 months, median progression-free survival – 18 months. All the relapses, except two, were distant. The possibility of successful SMV resection without PV/SMV reconstruction can be predicted before surgery by CT-based reconstructions. The mandatory anatomical conditions for the procedure were: 1) preserved SMV-SV confluence; 2) occluded SMV for any reason (tumor or thrombus); 3) well-developed inferior mesenteric vein collaterals with dilated intestinal veins; 4) no right-sided vein collaterals, and 5) no varices in the upper abdomen. Conclusion: “Low” LA PDACs involving SMV with all its tributaries can be radically and safely resected in highly and specifically selected cases without PV/SMV reconstruction with an acceptable survival rate.

locally advanced PDAC; vein resection without PV/SMV reconstruction; pancreatic cancer; portal venous collaterals; low pancreatic cancer; superior mesenteric vein occlusion; CT-based venous reconstructions

Medicine and Pharmacology, Surgery

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Pancreatectomy With En Bloc Superior Mesenteric Vein And All Its Tributaries Resection Without PV/SMV Reconstruction For “Low” Locally Advanced Pancreatic Cancer

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