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Commentary: Complex venous resection and reconstruction for locally advanced pancreatic cancer: Our approach

Published:September 11, 2020DOI:https://doi.org/10.1016/j.surg.2020.08.003
      Pancreatoduodenectomy (PD) with portal vein (PV) or superior mesenteric vein (SMV) or splenic vein (SpV) resection has been accepted as a well-tolerated and effective operation for patients with pancreatic cancer (PC) with PV invasion, but the complexity of the operation is quite variable depending on the extent of disease involvement to the portomesenteric-venous axis. In the article in this issue of Surgery, Kinny-Köster et al from the Johns Hopkins group have addressed the specific clinical and technical challenges in resection of PC with extensive venous invasion and described their operative techniques for complex venous resection and reconstruction.
      • Kinny-Köster B.
      • van Oosten F.
      • Habib J.R.
      • et al.
      Mesoportal bypass, interposition graft, and mesocaval shunt: surgical strategies to overcome superior mesenteric vein involvement in pancreatic cancer.
      Because locally advanced PC with this degree of extensive PV invasion usually has been considered an unresectable disease until recently, when effective modern systemic chemotherapy has become available, the complex clinical situations like intraoperative management of the obstructed PV with cavernous transformation or the optimal methods of reconstruction after a resection of long segment of PV/SMV were rarely discussed, and the data for short- and long-term outcomes were sparse in the literature. In this short commentary, we describe the general principles of our approach for PV resection and reconstruction for PC and make comments on the management specific to the 2 difficult situations they presented.
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