Portal homograft in pancreatic head cancer surgery: first experience

Close metadata

Recommended articles:

Successful surgical treatment of a patient with pancreatic cancer metastases in the liver after prior pancreatoduodenal resection. P.A. Herzen Journal of Oncology. 2024;(2):54-59

Endoscopic ultrasonography-guided biliary drainage in a patient with a locally advanced pancreatic tumor with obstructive jaundice. (Case report). Russian Journal of Evidence-Based Gastroenterology. 2024;(1):108-114

Surgical technique and early results of tricuspid valve replacement with mitral homograft. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;(5):499-505

Pancreaticoduodenectomy combined with multivisceral resections. Pirogov Russian Journal of Surgery. 2024;(11):77-83

A clinical case of extended combined pancreatectomy with vein reconstruction using a portal homograft in a 54-year-old patient with locally advanced ductal adenocarcinoma of the head of the pancreas is presented. Following the patient’s surgery, no data were obtained to confirm vascular thrombosis, circulatory disturbances in the portal and superior mesenteric veins, or impaired blood supply to the liver. Mesenteric-portal venous reconstruction with a portal homograft did not result in any vascular reconstruction-related complications and allowed a R0 resection to be achieved. On the example of the given clinical case we demonstrated the possibility of performing extended combined resection in locally advanced pancreatic cancer with involvement of portal and superior mesenteric veins. The use of a portal vein homograft may be a promising alternative to current angioplasty methods (autoprostheses, synthetic prostheses, xenografts).

Keywords:

pancreatic cancer

main vein invasion

pancreatectomy

homograft

vascular reconstruction

Authors:

Komarov R.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-3904-6415

Novikov S.S.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-9101-9484

Osminin S.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-9950-6575

Shchekoturov I.O.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-2167-8908

Zavaruev A.V.

Amur State Medical Academy

ORCID: 0000-0002-2906-0440

Shao M.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-5080-0247

Received:

17.08.2023

Accepted:

30.08.2023

List of references:

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. https://doi.org/10.3322/caac.21660
Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913-2921. https://doi.org/10.1158/0008-5472.CAN-14-0155
The Association of Oncologists of Russia, the Russian Society of Clinical Oncology. The Ministry of Health of the Russian Federation. Clinical guidelines. Pancreatic cancer. 2021. (In Russ.).
Garces-Descovich A, Beker K, Jaramillo-Cardoso A, James Moser A, Mortele KJ. Applicability of current NCCN Guidelines for pancreatic adenocarcinoma resectability: analysis and pitfalls. Abdom Radiol (NY). 2018;43(2):314-322. https://doi.org/10.1007/s00261-018-1459-6
Gilbert JW, Wolpin B, Clancy T, Wang J, Mamon H, Shinagare AB, Jagannathan J, Rosenthal M. Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification. Ann Oncol. 2017;28(9):2067-2076. https://doi.org/10.1093/annonc/mdx180
Kasumova GG, Conway WC, Tseng JF. The role of venous and arterial resection in pancreatic cancer surgery. Ann Surg Oncol. 2018;25(1):51-58. https://doi.org/10.1245/s10434-016-5676-3
Lapshyn H, Schulte T, Petruch N, Petrova E, Honselmann K, Deichmann S, Braun R, Kulemann B, Hoeppner J, Rades D, et al. Postoperative outcomes of tangential versus segmental resection and end-to-end reconstruction of the superior mesenterico-portal vein during pancreatoduodenectomy for pancreatic adenocarcinoma: a single-center experience. Anticancer Res. 2021;41(10):5123-5130. https://doi.org/10.21873/anticanres.15329
Kit OI, Katel’nitskaya OV, Maslov AA, Maksimov AYu, Gevorkyan YuA, Kolesnikov EN, Kharagezov DA, Snezhko AV, Malinin SA. Venous resections and reconstructions in surgery of pancreatic head cancer. Abstracts of the XXIII Russian Oncological Congress. Malignant Tumours. 2019;9(3S1):106. (In Russ.).
Kleive D, Labori KJ, Line PD, Gladhaug IP, Verbeke CS. Pancreatoduodenectomy with venous resection for ductal adenocarcinoma rarely achieves complete (R0) resection. HPB (Oxford). 2020;22(1):50-57. https://doi.org/10.1016/j.hpb.2019.05.005
Hackert T, Niesen W, Hinz U, Tjaden C, Strobel O, Ulrich A, Michalski CW, Büchler MW. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2017;43(2):358-363. https://doi.org/10.1016/j.pan.2016.05.186
Hackert T, Sachsenmaier M, Hinz U, Schneider L, Michalski CW, Springfeld C, Strobel O, Jäger D, Ulrich A, Büchler MW. Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients. Ann Surg. 2016;264(3):457-463. https://doi.org/10.1097/SLA.0000000000001850
Hartwig W, Gluth A, Hinz U, Koliogiannis D, Strobel O, Hackert T. Werner J, Büchler MW. Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg. 2016;103(12):1683-1694. https://doi.org/10.1002/bjs.10221
Moore GE, Sako Y, Thomas LB. Radical pancreatoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery. 1951;30(3):550-553.
Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg. 1996;224(3):342-347; discussion 347-349. https://doi.org/10.1097/00000658-199609000-00010
Lygidakis NJ, Singh G, Bardaxoglou E, Dedemadi G, Sgourakis G, Nestoridis J, Malliotakis A, Pedonomou M, Solomou EK, Safioleas M, et al. Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study. Hepatogastroenterology. 2004;51(56):427-433.
Tempero MA, Malafa MP, Al-Hawary M, Behrman SW, Benson AB, Cardin DB, Chiorean EG, Chung V, Czito B, Del Chiaro M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(4):439-457. https://doi.org/10.6004/jnccn.2021.0017
Ravikumar R, Sabin C, Abu Hilal M, Bramhall S, White S, Wigmore S, Imber CJ, Fusai G.; UK Vascular Resection in Pancreatic Cancer Study Group. Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom Multicenter Study. J Am Coll Surg. 2014;218(3):401-411. https://doi.org/10.1016/j.jamcollsurg.2013.11.017
The Association of Oncologists of Russia, the Russian Society of Clinical Oncology. The Ministry of Health of the Russian Federation. Clinical guidelines. Gastric cancer. 2020. 63p. (In Russ.).
Kleive D, Berstad AE, Verbeke CS, Haugvik SP, Gladhaug IP, Line PD, Labori KJ. Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery. HPB (Oxford). 2016;18(7):615-622. https://doi.org/10.1016/j.hpb.2016.05.010
Delpero JR, Boher JM, Sauvanet A, Le Treut YP, Sa-Cunha A, Mabrut JY, Chiche L, Turrini O, Bachellier P, Paye F. Pancreatic adenocarcinoma with venous involvement: is up-front synchronous portal-superior mesenteric vein resection still justified? A survey of the Association Française de Chirurgie. Ann Surg Oncol. 2015;22(6):1874-1883. https://doi.org/10.1245/s10434-014-4304-3
Dua MM, Tran TB, Klausner J, Hwa KJ, Poultsides GA, Norton JA, Visser BC. Pancreatectomy with vein reconstruction: technique matters. HPB (Oxford). 2015;17(9):824-831. https://doi.org/10.1111/hpb.12463
Muttillo EM, Felli E, Pessaux P. Cattell-Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection. J Surg Oncol. 2020;122(8):1612-1615. https://doi.org/10.1002/jso.26180
Hirono S, Kawai M, Tani M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbecks Arch Surg. 2014;399(4):461-471. https://doi.org/10.1007/s00423-014-1182-x
Neufang A, Savvidis S. Operative technique and morbidity of superficial femoral vein harvest. Gefasschirurgie. 2016;21(Suppl. 2):45-54. https://doi.org/10.1007/s00772-016-0170-6
Loveday BPT, Dib MJ, Sequeira S, Alotaiby N, Visser R, Barbas AS, Wei AC, Cleary SP, Moulton CA, Gallinger S, et al. Renal outcomes following left renal vein harvest for venous reconstruction during pancreas and liver surgery. HPB (Oxford). 2019;21(1):114-120. https://doi.org/10.1016/j.hpb.2018.07.015
Labori KJ, Kleive D, Khan A, Farnes I, Fosby B, Line PD. Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery — a systematic review. HPB (Oxford). 2021;23(4):483-494. https://doi.org/10.1016/j.hpb.2020.11.008
Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM, Sarmiento JM. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg. 2010;211(3):316-324. https://doi.org/10.1016/j.jamcollsurg.2010.04.005
Shcherba AE, Efimov DYu, Khar’kov DP, Rummo OO. Cadaveric venous allografts in hepatobiliopancreatic surgery. Annaly Khirurgicheskoi Gepatologii. 2016;21(2):32-38. https://doi.org/10.16931/1995-5464.2016232-38
Hwang S, Ha TY, Jung DH, Park JI, Lee SG. Portal vein interposition using homologous iliac vein graft during extensive resection for hilar bile duct cancer. J Gastrointest Surg. 2007;11(7):888-892. https://doi.org/10.1007/s11605-007-0146-7
Bacalbasa N, Balescu I, Vilcu M, Dima S, Iliescu L, Brezean I, Brasoveanu V, Popescu I. Superior mesenteric and portal vein reconstruction with cadaveric allograft during pancreatoduodenectomy — a case report and literature review. In vivo. 2020;34:787-791. https://doi.org/10.21873/invivo.11839
Mascoli C, D’Ambra M, Casadei R, Ricci C, Taffurelli G, Ancetti S, Stella A, Minni F, Freyrie A. Portal/superior mesenteric vein reconstruction during pancreatic resection using a cryopreserved arterial homograft. Dig Surg. 2015;32(4):284-290. https://doi.org/10.1159/000381194
Kleive D, Berstad AE, Sahakyan MA, Verbeke CS, Naper C, Haugvik SP, Gladhaug IP, Line PD, Labori KJ. Portal vein reconstruction using primary anastomosis or venous interposition allograft in pancreatic surgery. J Vasc Surg Venous Lymphat Disord. 2018;6(1):66-74. https://doi.org/10.1016/j.jvsv.2017.09.003
Meniconi RL, Santoro R, Guglielmo N, Vennarecci G, Lepiane P, Colasanti M, Ettorre GM. Pancreaticoduodenectomy with venous reconstruction using cold-stored vein allografts: long-term results of a single center experience. J Hepatobiliary Pancreat Sci. 2016;23(1):43-49. https://doi.org/10.1002/jhbp.299

Close metadata