Application of common iliac vein allograft for replacing portal vein-superior mesenteric vein transition area_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Kaiyu ¹ , SHI Jun ¹ , ZHAO Jing ² , WANG Yue ³ , SUN Yong ⁴ , HUANG Zhenya ¹ , HU Yongzhe ¹ , WU Guangdong ¹ , YU Lihan ¹ ,  XU Guangxun ¹ ,  LU Qian ¹

1. Department of Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P. R. China;
2. Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P. R. China;
3. Department of Oncology, Benxi Central Hospital, Benxi, Liaoning 117099, P. R. China;
4. Department of Hepatobiliary Surgery, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu 223300, P. R. China;

Corresponding author：

XU Guangxun, Email: drxugx@sina.com; LU Qian, Email: luqianbtch@163.com

Keywords：

Pancreatic cancer; pancreaticoduodenectomy; common iliac vein allograft; portal vein-superior mesenteric vein transition area; vascular replacement

DOI：

10.7507/1007-9424.202201035

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of common iliac vein allograft replacing the portal vein-superior mesenteric vein transition area invaded by pancreatic cancer. Methods The clinical data of a patient with pancreatic cancer admitted to the Beijing Tsinghua Changgung Hospital in December 2021 who underwent pancreaticoduodenectomy combined with common iliac vein allograft replacing the junction of portal vein, superior mesenteric vein and splenic vein were analyzed retrospectively. The patient was a 77-year-old man who complained of “epigastric pain for 1 month and pancreatic mass was found for 1 week”. After admission, the patient was diagnosed with pancreatic cancer through inspection, and then the surgery was required. Preoperative examination and intraoperative exploration confirmed that the junction of portal vein, superior mesenteric vein, and spleen vein was invaded by tumor. In addition, the length of the invaded vessels measured by preoperative 3D reconstruction image was 5.5 cm, and the distance between the broken end of portal vein and the broken end of superior mesenteric vein measured was 4.5 cm during the operation. After tumor and vessels were resected, vascular anastomosis could not be performed directly. After accurate evaluation, pancreaticoduodenectomy combined with common iliac vein allograft replacing the junction of portal vein, superior mesenteric vein and splenic vein was performed. The operative time was 11 h, and the intraoperative blood loss was 400 mL. After the operation, the routine treatment was performed in ICU and was transferred to the general ward on the 7th day. Postoperative laboratory tests were performed to monitor liver function changes routinely, and imaging examination were was performed to monitor portal venous system blood flow. Results Postoperative complications such as biliary fistula, pancreatic fistula, hemorrhage, infection and thrombosis were not occurred. Postoperative pathological diagnosis: pancreatic ductal adenocarcinoma, medium-low differentiation. Enhanced CT reexamination on the 2nd and 13th day after the operation showed that the blood flow at the junction of portal vein, superior mesenteric vein and splenic vein of the common iliac vein allograft was unobstructed, and there was no stenosis or thrombosis at each anastomosis. Conclusions The application of common iliac vein allograft replacing the portal vein-superior mesenteric vein transition area invaded by pancreatic cancer is safe and feasible. The short-term efficacy is satisfactory, and long-term prognosis remains to be further observed.

Citation： WANG Kaiyu, SHI Jun, ZHAO Jing, WANG Yue, SUN Yong, HUANG Zhenya, HU Yongzhe, WU Guangdong, YU Lihan, XU Guangxun, LU Qian. Application of common iliac vein allograft for replacing portal vein-superior mesenteric vein transition area. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(3): 302-307. doi: 10.7507/1007-9424.202201035 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	郎韧, 吕少诚, 贺强. 伴有门静脉系统侵犯的胰腺癌外科治疗. 中华肝胆外科杂志, 2020, 26(11): 801-804.
3.	Guilbaud T, Turrini O, Lemoine C, et al. Venous resection in pancreatic ductal adenocarcinoma: impact of surgical experience on early postoperative courses. Anticancer Res, 2017, 37(8): 4205-4213.
4.	Menon VG, Puri VC, Annamalai AA, et al. Outcomes of vascular resection in pancreaticoduodenectomy: single-surgeon experience. Am Surgeon, 2013, 79(10): 1064-1067.
5.	Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Brit J Surg, 2017, 104(11): 1539-1548.
6.	Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
7.	Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2014, 155(6): 977-988.
8.	Ono Y, Matsueda K, Koga R, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation. Brit J Surg, 2015, 102(3): 219-228.
9.	Sung H, Ferlay J, Siegel RL, et al. 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.
10.	范顺利, 姜涛, 潘飞, 等. 分支异体血管置换对胰腺癌术后患者左侧区域性门静脉高压的预防作用. 中华肝胆外科杂志, 2019, 25(5): 367-370.
11.	Ravikumar R, Sabin C, Abu Hilal M, et al. Portal vein resection in borderline resectable pancreatic cancer: a united kingdom multicenter study. J Am Coil Surg, 2014, 218(3): 401-411.
12.	Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2. 2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
13.	Hirono S, Kawai M, Tani M, et al. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbeck Arch Surg, 2014, 399(4): 461-471.
14.	Kitagawa H, Tajima H, Nakagawara H, et al. En bloc vascular resection for the treatment of borderline resectable pancreatic head carcinoma. Mol Clin Oncol, 2014, 2(3): 369-374.
15.	Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
16.	陈伟, 赖佳明, 张昆松, 等. 同种异体血管移植在胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术中的应用. 中华消化外科杂志, 2015, 14(10): 866-869.
17.	Fujii T, Nakao A, Yamada S, et al. Vein resections >3 cm during pancreatectomy are associated with poor 1-year patency rates. Surgery, 2015, 157(4): 708-715.
18.	王伟林, 叶松, 沈岩, 等. 同种异体血管移植在联合门静脉切除的胰腺癌根治术中的应用. 中华普通外科杂志, 2016, 31(5): 365-369.
19.	Smoot RL, Christein JD, Farnell MB. Durability of portal venous reconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg, 2006, 10(10): 1371-1375.
20.	王思珍, 王新波, 李民, 等. 三维可视化技术在胰腺肿瘤术前评估中应用的初步研究. 中华外科杂志, 2017, 55(10): 760-764.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 郎韧, 吕少诚, 贺强. 伴有门静脉系统侵犯的胰腺癌外科治疗. 中华肝胆外科杂志, 2020, 26(11): 801-804.
3. Guilbaud T, Turrini O, Lemoine C, et al. Venous resection in pancreatic ductal adenocarcinoma: impact of surgical experience on early postoperative courses. Anticancer Res, 2017, 37(8): 4205-4213.
4. Menon VG, Puri VC, Annamalai AA, et al. Outcomes of vascular resection in pancreaticoduodenectomy: single-surgeon experience. Am Surgeon, 2013, 79(10): 1064-1067.
5. Ravikumar R, Sabin C, Abu Hilal M, et al. Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Brit J Surg, 2017, 104(11): 1539-1548.
6. Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
7. Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2014, 155(6): 977-988.
8. Ono Y, Matsueda K, Koga R, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation. Brit J Surg, 2015, 102(3): 219-228.
9. Sung H, Ferlay J, Siegel RL, et al. 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.
10. 范顺利, 姜涛, 潘飞, 等. 分支异体血管置换对胰腺癌术后患者左侧区域性门静脉高压的预防作用. 中华肝胆外科杂志, 2019, 25(5): 367-370.
11. Ravikumar R, Sabin C, Abu Hilal M, et al. Portal vein resection in borderline resectable pancreatic cancer: a united kingdom multicenter study. J Am Coil Surg, 2014, 218(3): 401-411.
12. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2. 2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
13. Hirono S, Kawai M, Tani M, et al. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbeck Arch Surg, 2014, 399(4): 461-471.
14. Kitagawa H, Tajima H, Nakagawara H, et al. En bloc vascular resection for the treatment of borderline resectable pancreatic head carcinoma. Mol Clin Oncol, 2014, 2(3): 369-374.
15. Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
16. 陈伟, 赖佳明, 张昆松, 等. 同种异体血管移植在胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术中的应用. 中华消化外科杂志, 2015, 14(10): 866-869.
17. Fujii T, Nakao A, Yamada S, et al. Vein resections >3 cm during pancreatectomy are associated with poor 1-year patency rates. Surgery, 2015, 157(4): 708-715.
18. 王伟林, 叶松, 沈岩, 等. 同种异体血管移植在联合门静脉切除的胰腺癌根治术中的应用. 中华普通外科杂志, 2016, 31(5): 365-369.
19. Smoot RL, Christein JD, Farnell MB. Durability of portal venous reconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg, 2006, 10(10): 1371-1375.
20. 王思珍, 王新波, 李民, 等. 三维可视化技术在胰腺肿瘤术前评估中应用的初步研究. 中华外科杂志, 2017, 55(10): 760-764.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of common iliac vein allograft for replacing portal vein-superior mesenteric vein transition area

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content