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Pancreaticoduodenectomy with portal vein/superior mesenteric vein resection for patients with pancreatic cancer with venous invasion

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 429-435页

作者： Wei-Lin Wang Song Ye Sheng Yan Yan Shen Min Zhang Jian Wu Shu-Sen Zheng Division of Hepatobiliary Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine

BACKGROUND： With the development of new surgical tech- niques, pancreaticoduodenectomy （PD） with portal vein or superior mesenteric vein （PV/SMV） resection has been used in the treatment of patients with borderline resectable pan- creatic cancer. However, opinions of surgeons differ in the effectiveness of this surgical technique. This study aimed to investigate the effectiveness of this approach in patients with pancreatic cancer. METHODS： Follow-up visits and retrospective analysis were carried out of 208 patients with pancreatic cancer who had undergone PD （PD group） and PD combined with PV/SMV resection and reconstruction （PDVR group） from June 2009 to May 2013 at our center. Statistical analysis was performed to compare the clinical features, the difference of survival time and risk factors of venous invasion in pancreatic cancer. Factors relating to postoperative survival time of pancreatic cancer were also investigated. RESULTS： In the PDVR group, which consisted of 42 cases, the 1-, 2- and 3-year survival rates were 70%, 41% and 16%, respective- ly and the median survival time was 20.0 months. Among the 166 patients in the PD group, the 1-, 2- and 3-year survival rates were 80%, 52%, and 12%, respectively with the median survival time of 26.0 months. No significant difference in survival time and R0 resection ratio was found between the two groups. Lum- bodorsal pain, tumor with pancreatic capsular invasion and bile duct infiltration were found to be independent risk factors for PV invasion in pancreatic cancer. In addition, non R0 resection,large tumor size （〉2 cm） and poorly differentiated tumor were independent risk factors for survival time in post-PD. CONCLUSIONS： The tumor has a higher chance of venous invasion if preoperative imagings indicate that it juxtaposes with the vessel. Lumbodorsal pain is the chief complaint. Pa- tients with pancreatic cancer associated with PV involvement should receive PDVR for R0 resection when preoperational assessment s

关键词： pancreatic cancer pancreaticoduodenectomy portal vein resection superior mesenteric vein

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Ligamentum teres hepatis as a graft for portal and/or superior mesenteric vein reconstruction:From bench to bedside

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 674-686页

作者： Wen-Tao Zhu Hai-Tao Wang Qing-Hai Guan Fan Zhang Chang-Xi Zhang Feng-Ai Hu Bao-Lei Zhao Lei Zhou Qiang Wei Hai-Bin Ji Ting-Liang Fu Xing-Yuan Zhang Rui-Tao Wang Qiang-Pu Chen Department of Hepatobiliary Surgery Binzhou Medical University HospitalBinzhou 256600Shandong ProvinceChina Department of Hepatobiliary Surgery Binzhou Medical University Affiliated Yantai HospitalYantai 264110Shandong ProvinceChina Department of Hepatobiliary Surgery and Clinical Nutrition Center Binzhou Medical University HospitalBinzhou 256600Shandong ProvinceChina Department of Clinical Medicine Laboratory Binzhou Medical University HospitalBinzhou 256600Shandong ProvinceChina Department of Pediatric Surgery Binzhou Medical University HospitalBinzhou 256600Shandong ProvinceChina Department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi'an 710061Shannxi ProvinceChina

BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical *** are various grafts currently used for PV and/or SMV reconstruction,but each of these grafts have certain ***,it is necessary to explore novel grafts that have an extensive resource pool,are low cost with good clinical application,and are without immune response rejection or additional damage to *** To observe the anatomical and histological characteristics of the ligamentum teres hepatis(LTH)and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy *** In 107 patients,the post-dilated length and diameter in resected LTH specimens were *** general structure of the LTH specimens was observed by hematoxylin and eosin(HE)*** fibers(CFs),elastic fibers(EFs),and smooth muscle(SM)were visualized by Verhoeff-Van Gieson staining,and the expression of CD34,factor VIII-related antigen(FVIIIAg),endothelial nitric oxide synthase(eNOS),and tissue type plasminogen activator(t-PA)were detected using immunohistochemistry in LTH and PV(control)endothelial *** and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies,and the outcomes were retrospectively *** The post-dilated length of LTH was 9.67±1.43 cm,and the diameter at a pressure of 30 cm H2O was 12.82±1.32 mm at the cranial end and 7.06±1.88 mm at the caudal *** cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH *** relative amounts of EFs,CFs and SM in the LTH were similar to those in the PV[EF(%):11.23±3.40 vs 11.57±2.80,P=0.62;CF(%):33.51±7.71 vs 32.11±4.82,P=0.33;SM(%):15.61±5.26 vs 16.74±4.83,P=0.32].CD34,FVIIIAg,eNOS,and t-PA were expressed in both LTH and PV endothelial *** PV and

关键词： Ligamentum teres hepatis Pancreaticoduodenectomy Portal vein superior mesenteric vein Vascular grafting Pancreaticobiliary malignancy

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Small Bowel Stricture Complicating superior mesenteric vein Thrombosis

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2012年第1期32卷 146-148页

作者：杨进沈来根郑雪咏朱越锋刘震杰 Department of General Surgery Affiliated Sir Run Run Shaw HospitalSchool of MedicineZhejiang University

superior mesenteric vein (SMV) thrombosis is a relatively rare *** patients may be successfully treated with anti-coagulation ***,bowel stricture may develop due to intes-tinal ischemia which may require surgical *** report describes a rare case of small bowel stricture occurring one month after successful treatment of SMV *** segmental resection of strictured bowel,the patient’s post-operative course was uneventful.

关键词： superior mesenteric vein thrombosis bowel stricture

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Small bowel stricture complicating superior mesenteric vein thrombosis

Small bowel stricture complicating superior mesenteric vein ...

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2013年浙江省外科学学术年会

作者： Jin Yang Lai-gen Shen Xue-yong Zheng Yue-feng Zhu Zheng-jie Liu Department of General Surgery Affiliated Sir Run Run Shaw HospitalSchool of MedicineZhejiang University

Summary superior mesenteric vein(SMV) thrombosis is a relatively rare *** patients may be satisfied by the efficacy of conservative *** bowel stricture may develop due to intestine *** report describes a rare case of small bowel stricture occurring 1 month after successful treatment of sueperior mesenteric vein *** segmental resection of strictured bowel,the patient’ s post-operative course was uneventful,and follow-up examinations revealed an unremarkable state of health.

关键词： superior mesenteric vein thrombosis bowel stricture

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Multidetector computer tomography and magnetic resonance imaging of double superior mesenteric veins:A case report

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World Journal of Clinical Cases 2024年第17期12卷 3265-3270页

作者： Wei Tang Song Peng Department of Radiology Chongqing Health Center for Women and ChildrenWomen and Children’s Hospital of Chongqing Medical UniversityChongqing 401147China Department of Radiology Sichuan Key Laboratory of Medical ImagingAffiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina

BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)*** SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver *** and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double *** The double SMVs are a congenital abnormality without potential clinical *** need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

关键词： superior mesenteric vein Anatomic variation Magnetic resonance imaging Multidetector computer tomography Case report

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Prognosis and feasibility of en-bloc vascular resection in stage Ⅱ pancreatic adenocarcinoma

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World Journal of Gastroenterology 2010年第8期16卷 997-1002页

作者： K Dilip Chakravarty Jun-Te Hsu Chun-Nan Yeh Ta-Sen Yeh Tsann-Long Hwang Miin-Fu Chen Department of General Surgery Chang Gung Memorial Hospital

AIM:To establish the prognosis and feasibility of en-bloc vascular resection of stage pancreatic adenocarcinoma of the head and uncinate ***:We retrospectively analyzed 87 patients with stage pancreatic adenocarcinoma,who were subjected to pancreaticoduodenectomy (PD) and pylo-rus-preserving PD (PPPD) between 1996 and 2006 in Chang Gung Memorial Hospital,Taiwan. Twelve and 75 patients underwent PD/PPPD with and without resection of portal vein/superior mesenteric vein (PV/SMV),***:The overall 1-and 3-year survival rates of patients undergoing PD/PPPD with and without vas-cular resection were 50.0% and 16.7%,and 44.4% and 12.2%,respectively. Morbidity and mortality rates in the PV/SMV resection vs non-resection group were 50.0% and 0.0%,and 40.0% and 2.7%,respectively. In multivariate analysis,serum bilirubin,histological differentiation and adjuvant chemotherapy were independent prognostic factors that influenced ***:In stage adenocarcinoma of the pancreatic head and uncinate process,serum bilirubin,histological differentiation and adjuvant chemotherapy were independent prognostic factors,and en-bloc vascular resection is a feasible option in carefully selected patients.

关键词： Pancreatic neoplasms Adenocarcinoma Portal vein superior mesenteric vein Pancreaticoduo-denectomy Chemotherapy

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Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

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World Journal of Gastroenterology 2009年第24期15卷 3038-3045页

作者： Mao-Qiang Wang Han-Ying Lin Li-Ping Guo Feng-Yong Liu Feng Duan Zhi-Jun Wang Department of Interventional Radiology Chinese PLA General Hospital Beijing 100853 China

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 *** access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 *** improvement was seen in these patients within 12-24 h of the *** complications were *** 6 patients were discharged 6-14 d(8±2.5 d)after *** mean duration of follow-up after hospital discharge was 40±16.5 *** and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

关键词： Mechanical thrombectomy Portal vein Splenectomy superior mesenteric vein Thrombolysis Thrombosis

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Multidetector computed tomography three-dimensional and multiplanar reconstruction diagnosis of a rare cause of gastrointestinal bleeding: A case report

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World Journal of Gastrointestinal Surgery 2021年第1期13卷 87-95页

作者： Yong Cai Xiao-Bo Chen Da-Hai Mai Ping Wu Yong-Hai Chen Hua Chen Department of Diagnostic Imaging Maoming People’s HospitalMaoming 525000Guangdong ProvinceChina Department of Oncology Maoming People's HospitalMaoming 525000Guangdong ProvinceChina Department of Gastroenterology Maoming People's HospitalMaoming 525000Guangdong ProvinceChina

BACKGROUND Anastomosis of the testicular vein with the superior mesenteric vein rarely causes severe gastrointestinal *** date,there have been few studies describing its appearance on medical ***,we present multidetector computed tomography three-dimensional and multiplanar reconstruction(MPR)images of a typical digital subtraction angiography showing proven ectopic bleeding and provide the first review of the image *** SUMMARY A 68-year-old man who had been rushed to the hospital with a four-day history of melena and fainting underwent multiple esophagogastroduodenoscopy procedures that failed to identify the source of *** used MPR combined with three-dimensional reconstruction images,and found that the testicular vein had anastomosed with the superior mesenteric vein,and they clustered together in the jejunal vessel wall,which caused severe gastrointestinal *** subtraction angiography confirmed the location of *** transfusion and embolization therapy,the patient’s condition *** Computed tomography-MPR combined with three-dimensional images offers significant value in the localization and qualitative assessment of rare gastrointestinal *** features of multiphase spiral scanning can improve the accuracy of the diagnosis.

关键词： Testicular vein superior mesenteric vein Gastrointestinal bleeding Multiplanar reconstruction Three-dimensional images Case report

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Pancreatic cancer surgery with vascular resection: current concepts and perspectives

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Journal of Pancreatology 2019年第1期2卷 1-5页

作者： Artur Rebelo Christoph W.Michalski Jörg Ukkat Jörg Kleeff Department of Visceral Vascular and Endocrine SurgeryHalle University HospitalMartin-Luther-University Halle-WittenbergHalleGermany

Pancreatic cancer is a devastating disease and resection at an early disease stage is the best chance of cure. Less than 20% of all patients present with a resectable tumor, while another 20% to 30% have locally advanced pancreatic cancer and the majority of the patient suffer from metastatic disease. Recently, it has been recognized that there is a 4th group of patients with so-called borderline resectable disease. Here, the tumor approaches or infiltrates the vascular axis (superior mesenteric vein/portal vein and/or superior mesenteric/hepatic artery/celiac trunk). While a large number of tumors with suspected venous infiltration can be resected with concomitant venous resection and reconstruction, arterial infiltration has been considered a contraindication to resection. Neoadjuvant treatment with combination chemotherapy protocols with or without radiotherapy has allowed for higher resection rates even in patients with arterial invasion. Here, we review the contemporary literature on extensive pancreatic cancer surgery with vascular resection and reconstruction.

关键词： Borderline pancreatic cancer Celiac artery Hepatic artery Neoadjuvant chemotherapy Pancreatic cancer Portal vein superior mesenteric artery superior mesenteric vein Vascular resection

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