Replacement of portal vein during pancreatectomy for carcinoma.

Three patients are described in whom the portal vein, surrounded but not penetrated by pancreatic carcinoma, was resected and replaced by an expanded Teflon (Gore-Tex) tube. One patient, who has survived 32 months without recurrence of disease, had a radiographically patent graft at 2 and 17 months after operation. A second survivor has a patent graft at 8 months. The third patient died 10 days after operation with an open prosthesis. Excision of involved portal vein during pancreatoduodenectomy for carcinoma of the pancreas is justified in the absence of metastases. Vein grafting is the best means of portal vein reconstruction. Gore-Tex appears to be a suitable prosthesis when the portal vein must be sacrificed. Its clinical success in terms of patency substantiates previous experience in experimental animals.