Bachellier Philippe, de Mathelin Pierre, Addeo Pietro
Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Ann Surg Oncol. 2025 Apr 1. doi: 10.1245/s10434-025-17271-3.
Pancreatectomies with superior mesenteric artery (SMA) resection are technically challenging. With the advent of FOLFIRNOX chemotherapy, resection of the SMA is performed in selected patients with locally advanced pancreatic cancer (LAPC), in centers of excellence by highly skilled pancreatic-vascular surgeons treating a large volume of LAPCs. METHODS: The patient was a 64-year-old female with an LAPC treated with 11 cycles of FOLFIRINOX induction chemotherapy. The SMA, the superior mesenteric vein (SMV), and a replaced right hepatic artery (r-RHA) were encased. A temporary mesenterico-portal shunt (TMPS), using a 25 cm Goretex tube between the origin of the SMV and the right side of the portal vein, was used. This TMPS (1) lessens portal hypertension in case of SMV obstruction; (2) maintains adequate liver venous perfusion during dissection; (3) gives the mesentery enough mobility to avoid graft for SMA resection; and (4) avoids simultaneous venous and arterial clamping. A mesenteric approach was performed to isolate the SMA. Upon heparin bolus, the r-RHA was re-implanted on the gastroduodenal artery stump, the SMA on the aorta, the SMV on the portal vein, and the splenic vein on the left renal vein.
Postoperative course was uneventful. Pathology showed pT4N0R1 pancreatic adenocarcinomas. Three years later, the patient recurred on the left adrenal gland and was treated by external radiotherapy. Five years later, the patients is alive under chemotherapy.
Pancreaticoduodenectomy with SMA and SMV using a transitory mesentericoportal shunt (The Strasbourg technique) is a standardized technique used to manage patients with LAPC at our unit.
肠系膜上动脉（SMA）切除的胰腺切除术在技术上具有挑战性。随着FOLFIRNOX化疗的出现，在一些卓越中心，由经验丰富、大量治疗局部晚期胰腺癌（LAPC）的胰腺血管外科医生，对选定的局部晚期胰腺癌患者进行SMA切除。
该患者为64岁女性，患有LAPC，接受了11个周期的FOLFIRINOX诱导化疗。SMA、肠系膜上静脉（SMV）和一支替代右肝动脉（r-RHA）被肿瘤包绕。使用一根25厘米的戈尔特斯管在SMV起始部和门静脉右侧之间建立了一个临时肠系膜-门静脉分流（TMPS）。这个TMPS：（1）在SMV梗阻时减轻门静脉高压；（2）在解剖过程中维持足够的肝脏静脉灌注；（3）给予肠系膜足够的活动度以避免为SMA切除而进行血管移植；（4）避免同时进行静脉和动脉钳夹。采用肠系膜入路分离SMA。给予肝素推注后，将r-RHA重新植入胃十二指肠动脉残端，将SMA植入主动脉，将SMV植入门静脉，将脾静脉植入左肾静脉。
术后过程顺利。病理显示为pT4N0R1胰腺腺癌。三年后，患者左侧肾上腺复发，接受了外照射放疗。五年后，患者在化疗下存活。
采用暂时性肠系膜-门静脉分流（斯特拉斯堡技术）进行SMA和SMV切除的胰十二指肠切除术是我们单位用于治疗LAPC患者的标准化技术。
