Use of a temporary intraoperative mesentericoportal shunt for pancreatic resection for locally advanced pancreatic cancer with portal vein occlusion and portal hypertension

• Published in: Surgery 2014-03, Vol.155 (3), p.449-456
• Main Authors: Bachellier, Philippe, MD, PhD, Rosso, Edoardo, MD, Fuchshuber, Pascal, MD, PhD, FACS, Addeo, Pietro, MD, David, Patrice, MD, Oussoultzoglou, Elie, MD, Lucescu, Ionut, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical; Blood Vessel Prosthesis Implantation - methods; Carcinoma, Pancreatic Ductal - complications; Carcinoma, Pancreatic Ductal - drug therapy; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - surgery; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Hypertension, Portal - etiology; Male; Mesenteric Veins - pathology; Mesenteric Veins - surgery; Middle Aged; Neoadjuvant Therapy; Pancreatectomy - methods; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Portal Vein - pathology; Portal Vein - surgery; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Surgery; Survival Analysis; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2013.09.003

Background Our aim was to evaluate the perioperative morbidity and survival of a selected group of patients with locally advanced pancreatic ductal adenocarcinoma (PDAC) and malignant obstruction of portal axis inducing portal hypertension (PH) who underwent a curative intent pancreatic resection, after neoadjuvant chemotherapy, adopting a new type of temporary intraoperative mesentericoportal shunt (TMPS). Methods We analyzed the perioperative data and survival outcome of 15 patients with locally advanced PDAC and PH who underwent pancreatoduodenectomy combined with vascular resections between October 2008 and October 2012 using this TMPS. Results There was no perioperative mortality. Postoperative morbidity occurred in 7 patients without any postoperative liver failure. All patients underwent mesentericoportal venous resection, 11 of whom had a concomitant arterial resection. The mean ± SD follow-up was 16 ± 10 months (range, 4–40; median 15). Overall survival rates of patients were 78% and 11% at 1 and at 3 years, respectively. Median survival was 17 months. The 1-year disease-free survival was 36%. Conclusion The use of this form of TMPS allowed us to achieve PD or total pancreatectomy in patients with locally advanced PDAC and PH without postoperative mortality but with increased morbidity. The relevance of such an aggressive approach is yet to be determined.