Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, USA.
Department of Hepatobiliary Surgery and Liver Transplantation, La Pitié Salpetrière Hospital, Université Pierre et Marie Curie (UPMC), Assistance Publique-Hôpitaux de Paris, Paris, France.
Ann Surg Oncol. 2019 Feb;26(2):652. doi: 10.1245/s10434-018-07093-x. Epub 2018 Dec 11.
Patients with locally advanced pancreatic cancer (LAPC) represent a challenging group to treat, given the involvement of major vascular structures. In selected patients with favorable biology, temporary mesocaval shunt can facilitate the resection and allow for a safer procedure with enhanced exposure to the superior mesenteric vessels.
We present a video of a pancreaticoduodenectomy (PD) with temporary mesocaval shunt with left internal jugular (LIJ) vein conduit.
A 65-year-old woman presented with LAPC in the uncinate, causing total occlusion of the superior mesenteric vein (SMV) and encasement of the first jejunal artery. After neoadjuvant therapy and evidence of disease stability, a decision was made to perform a PD with a temporary mesocaval shunt to divert mesenteric flow to reduce blood loss and prevent bowel ischemia. During the procedure, the main mesenteric collateral (ileocolic vein) was divided to create the shunt to the inferior vena cava (IVC) with LIJ interposition. The remaining mesenteric tributaries involved by the tumor were divided. The uncinate dissection was performed using a superior mesenteric artery-first approach. Once the resection was completed, the shunt was stapled from the IVC and the graft transposed to the upper SMV. Standard reconstruction was performed. Total operative time was 536 min, and estimated blood loss was 250 cc without transfusions. No perioperative complications occurred.
In selected patients with LAPC, PD with temporary mesocaval shunt can facilitate resection and venous reconstruction in patients with complete portal vein/SMV occlusion.
局部晚期胰腺癌（LAPC）患者由于涉及主要血管结构，治疗具有挑战性。在具有有利生物学特征的选定患者中，临时肠系膜腔静脉分流术可以促进切除，并允许更安全的手术，更好地暴露肠系膜上血管。
我们展示了一例带有临时肠系膜腔静脉分流术和左颈内静脉（LIJ）静脉导管的胰十二指肠切除术（PD）的视频。
一名 65 岁女性患有位于胰钩突的 LAPC，导致肠系膜上静脉（SMV）完全闭塞并包裹第一空肠动脉。在新辅助治疗和疾病稳定证据后，决定进行 PD 加临时肠系膜腔静脉分流术，以分流肠系膜血流，减少出血并防止肠缺血。在手术过程中，将主要肠系膜侧支（回结肠静脉）切开以创建分流至下腔静脉（IVC）的分流，并插入 LIJ 静脉。将肿瘤累及的剩余肠系膜支流分开。采用肠系膜上动脉优先方法进行钩突解剖。完成切除后，从 IVC 用吻合器夹闭分流，并将移植物转移到上 SMV。标准重建。总手术时间为 536 分钟，估计出血量为 250 毫升，无输血。无围手术期并发症发生。
在局部晚期胰腺癌患者中，对于完全门静脉/SMV 闭塞的患者，PD 加临时肠系膜腔静脉分流术可促进切除和静脉重建。
