Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer: Initial experience from the Medical College of Wisconsin

Kathleen K. Christians, Kevin Riggle, Rebecca Keim, Sam Pappas, Susan Tsai, Paul Ritch, Beth Erickson, Douglas B. Evans

Research output: Contribution to journalArticle

Abstract

Background. Vascular resection/reconstruction at the time of pancreatectomy is performed when limited vascular involvement is the only barrier to complete resection. Splenic vein (SV) ligation facilitates resection/reconstruction of the superior mesenteric vein (SMV) - portal vein (PV) confluence and widely exposes the superior mesenteric artery and celiac origin. If the inferior mesenteric vein does not provide for retrograde decompression, SV ligation may result in sinistral portal hypertension; creation of a distal splenorenal shunt (DSRS) can prevent this complication. Additional complexity occurs in the setting of cavernous transformation of the PV. A mesocaval shunt (MCS) can be utilized to temporarily divert portal flow allowing for a safe portal dissection. Herein we report our initial experience utilizing DSRS and MCS at the time of pancreatectomy for cancer. Methods. We reviewed all patients who underwent pancreatic resection for cancer and had either a DSRS and/or MCS performed between January 1, 2009 and February 1, 2012. Results. Of 11 patients identified, 10 had adenocarcinoma, 9 underwent standard or extended pancreaticoduodenectomy, and 2 underwent total pancreatectomy. Median operative time was 9.5 hours, median blood loss was 1,000 mL and median duration of stay was 10 days. There were no mortalities. There was 1 Clavien grade III complication during the index admission and 3 others were readmitted. No patient required reoperation. Conclusion. We provide proof of concept that extended pancreatic resection in the setting of limited vascular involvement can be safely performed. This is the first report utilizing MCS and DSRS to facilitate resection of the SMV-PV confluence in the setting of cavernous transformation of the PV. (Surgery 2013;154:123-31.)

Original languageEnglish (US)
Pages (from-to)123-131
Number of pages9
JournalSurgery
Volume154
Issue number1
DOIs
StatePublished - Jul 2013
Externally publishedYes

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Surgical Splenorenal Shunt
Pancreatectomy
Mesenteric Veins
Splenic Vein
Blood Vessels
Portal Vein
Ligation
Neoplasms
Pancreaticoduodenectomy
Superior Mesenteric Artery
Portal Hypertension
Operative Time
Decompression
Pancreatic Neoplasms
Reoperation
Abdomen
Dissection
Adenocarcinoma
Mortality

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer : Initial experience from the Medical College of Wisconsin. / Christians, Kathleen K.; Riggle, Kevin; Keim, Rebecca; Pappas, Sam; Tsai, Susan; Ritch, Paul; Erickson, Beth; Evans, Douglas B.

In: Surgery, Vol. 154, No. 1, 07.2013, p. 123-131.

Research output: Contribution to journalArticle

Christians, Kathleen K. ; Riggle, Kevin ; Keim, Rebecca ; Pappas, Sam ; Tsai, Susan ; Ritch, Paul ; Erickson, Beth ; Evans, Douglas B. / Distal splenorenal and temporary mesocaval shunting at the time of pancreatectomy for cancer : Initial experience from the Medical College of Wisconsin. In: Surgery. 2013 ; Vol. 154, No. 1. pp. 123-131.
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abstract = "Background. Vascular resection/reconstruction at the time of pancreatectomy is performed when limited vascular involvement is the only barrier to complete resection. Splenic vein (SV) ligation facilitates resection/reconstruction of the superior mesenteric vein (SMV) - portal vein (PV) confluence and widely exposes the superior mesenteric artery and celiac origin. If the inferior mesenteric vein does not provide for retrograde decompression, SV ligation may result in sinistral portal hypertension; creation of a distal splenorenal shunt (DSRS) can prevent this complication. Additional complexity occurs in the setting of cavernous transformation of the PV. A mesocaval shunt (MCS) can be utilized to temporarily divert portal flow allowing for a safe portal dissection. Herein we report our initial experience utilizing DSRS and MCS at the time of pancreatectomy for cancer. Methods. We reviewed all patients who underwent pancreatic resection for cancer and had either a DSRS and/or MCS performed between January 1, 2009 and February 1, 2012. Results. Of 11 patients identified, 10 had adenocarcinoma, 9 underwent standard or extended pancreaticoduodenectomy, and 2 underwent total pancreatectomy. Median operative time was 9.5 hours, median blood loss was 1,000 mL and median duration of stay was 10 days. There were no mortalities. There was 1 Clavien grade III complication during the index admission and 3 others were readmitted. No patient required reoperation. Conclusion. We provide proof of concept that extended pancreatic resection in the setting of limited vascular involvement can be safely performed. This is the first report utilizing MCS and DSRS to facilitate resection of the SMV-PV confluence in the setting of cavernous transformation of the PV. (Surgery 2013;154:123-31.)",
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N2 - Background. Vascular resection/reconstruction at the time of pancreatectomy is performed when limited vascular involvement is the only barrier to complete resection. Splenic vein (SV) ligation facilitates resection/reconstruction of the superior mesenteric vein (SMV) - portal vein (PV) confluence and widely exposes the superior mesenteric artery and celiac origin. If the inferior mesenteric vein does not provide for retrograde decompression, SV ligation may result in sinistral portal hypertension; creation of a distal splenorenal shunt (DSRS) can prevent this complication. Additional complexity occurs in the setting of cavernous transformation of the PV. A mesocaval shunt (MCS) can be utilized to temporarily divert portal flow allowing for a safe portal dissection. Herein we report our initial experience utilizing DSRS and MCS at the time of pancreatectomy for cancer. Methods. We reviewed all patients who underwent pancreatic resection for cancer and had either a DSRS and/or MCS performed between January 1, 2009 and February 1, 2012. Results. Of 11 patients identified, 10 had adenocarcinoma, 9 underwent standard or extended pancreaticoduodenectomy, and 2 underwent total pancreatectomy. Median operative time was 9.5 hours, median blood loss was 1,000 mL and median duration of stay was 10 days. There were no mortalities. There was 1 Clavien grade III complication during the index admission and 3 others were readmitted. No patient required reoperation. Conclusion. We provide proof of concept that extended pancreatic resection in the setting of limited vascular involvement can be safely performed. This is the first report utilizing MCS and DSRS to facilitate resection of the SMV-PV confluence in the setting of cavernous transformation of the PV. (Surgery 2013;154:123-31.)

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