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Commentary: Venous resection and reconstruction at the time of pancreatectomy for cancer

Published:September 23, 2020DOI:https://doi.org/10.1016/j.surg.2020.08.004
      Much of today’s current literature discussing the technical aspects of pancreatic cancer surgery has focused on the if, when, and how of arterial resection in locally advanced disease, leaving one to believe venous resection, especially in the hands of experienced surgeons, is a foregone conclusion. In many circumstances, however, the arteries are much more robust than the veins and the perineurium can sometimes be removed, rendering arterial resection/reconstruction occasionally unnecessary to achieve an R0 resection. In this issue of Surgery, well-known experts in the field from Johns Hopkins and Universitair Medisch Centrum Utrecht discuss the intricacies of tumor-associated venous encasement, which in some circumstances can be much more difficult to manage than arterial abutment. The authors present 5 complex intraoperative approaches to venous resection or reconstruction: collateral preservation, mesoportal bypass preresection, mesoportal interposition grafting after resection, mesocaval shunt, and various combinations preferentially using autologous veins or cryopreserved vascular allografts.
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