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Total Laparoscopic Pancreaticoduodenectomy with Venous Reconstruction for Pancreatic Head Cancer with Involvement of the Superior Mesenteric Vein–Portal Vein Confluence

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic pancreaticoduodenectomy with venous reconstruction is not commonly performed due to its technical challenges. In this video, we focus on the technical aspects for how to perform this procedure safely.

Methods

In a 69-year-old female with jaundice and diarrhea, a computed tomography scan showed a mass in the head of the pancreas, with a 180-degree involvement of the superior mesenteric vein. Endoscopic retrograde cholangiopancreatography with stenting was performed together with endoscopic ultrasound and fine-needle aspiration. Biopsy showed well-differentiated adenocarcinoma. The patient underwent six cycles of neoadjuvant chemotherapy, with reduction of the vein involvement to 90 degrees. The mass invaded the right lateral aspect of the superior mesenteric vein–portal vein confluence. As a result, this portion of the vein was removed en bloc with the specimen. The vascular defect was repaired using two running sutures. Once the choledocojejunostomy and intussuscepted pancreatico-gastric anastomosis were completed, the specimen was removed via a small subxiphoid incision.

Results

Operative time was 6 h and 30 min, blood loss was 50 mL, and hospital stay was 12 days. Histopathological examination was ypT3 N1 (1 of 18 lymph nodes was positive). All margins were negative.

Conclusion

Laparoscopic pancreaticoduodenectomy with vascular reconstruction can be performed safely in selected cases of pancreatic head cancer with vein involvement. Advanced laparoscopic skills are necessary to complete such procedures safely.

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References

  1. Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobil Pancreat Surg. 2009;16:731–740.

    Article  CAS  Google Scholar 

  2. Liao CH, Wu YT, Liu YY, Wang SY, Kang SC, Yeh CN, et al. Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy. World J Surg. 2016;40:1218–1225.

    Article  Google Scholar 

  3. Awad ZT. Totally laparoscopic pancreaticoduodenectomy for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol. 2014;21:3439.

    Article  Google Scholar 

  4. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001;182(2):120–9.

    Article  CAS  Google Scholar 

  5. Delpero JR, Boher JM, Sauvanet A, Le Treut YP, Sa-Cunha A, Mabrut JY, et al. 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):1874–83.

    Article  Google Scholar 

  6. Addeo P, Rosso E, Fuchshuber P, Oussoultzoglou E, De Blasi V, Simone G, et al. Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy. Oncology. 2015;89(1):37–46.

    Article  CAS  Google Scholar 

  7. Pittau G, Sànchez-Cabùs S, Laurenzi A, Gelli M, Cunha AS. Laparoscopic Pancreaticoduodenectomy: Right Posterior Superior Mesenteric Artery “First” Approach. Ann Surg Oncol. 2015;22 Suppl 3:S345–8.

    Article  Google Scholar 

  8. Zimmitti G, Manzoni A, Addeo P, Garatti M, Zaniboni A, Bachellier P, et al. Laparoscopic pancreatoduodenectomy with superior mesenteric artery-first approach and pancreatogastrostomy assisted by mini-laparotomy. Surg Endosc. 2016;30(4):1670–1.

    Article  Google Scholar 

  9. Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 1995;222:580–592.

    Article  CAS  Google Scholar 

  10. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767–771.

    Article  Google Scholar 

  11. Rosso E, Bachellier P, Oussoultzoglou E, Scurtu R, Meyer N, Nakano H, et al. Toward zero pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. Am J Surg. 2006;191(6):726–32; discussion 733–4.

    Article  Google Scholar 

  12. Bachellier P, Oussoultzoglou E, Rosso E, Scurtu R, Lucescu I, Oshita A, et al. Pancreatogastrostomy as a salvage procedure to treat severe postoperative pancreatic fistula after pancreatoduodenectomy. Arch Surg. 2008;143(10):966–70; discussion 971.

    Article  Google Scholar 

  13. Xu J, Ji SR, Zhang B, Ni QX, Yu XJ. Strategies for pancreatic anastomosis after pancreaticoduodenectomy: what really matters? Hepatobiliary Pancreat Dis Int. 2018;17(1):22–26.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France

    Giovanni Maria Garbarino MD, David Fuks MD, PhD, Jane Cowan MD, Marc Ward MD, Fabrizio Moisan MD, Gianfranco Donatelli MD, Marc Beaussier MD & Brice Gayet MD, PhD

Authors
  1. Giovanni Maria Garbarino MD
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  2. David Fuks MD, PhD
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  3. Jane Cowan MD
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  4. Marc Ward MD
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  5. Fabrizio Moisan MD
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  6. Gianfranco Donatelli MD
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  7. Marc Beaussier MD
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  8. Brice Gayet MD, PhD
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Corresponding author

Correspondence to Giovanni Maria Garbarino MD.

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Disclosures

Giovanni Maria Garbarino, David Fuks, Jane Cowan, Marc Ward, Fabrizio Moisan, Gianfranco Donatelli, Marc Beaussier, and Brice Gayet have no disclosures to declare.

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Garbarino, G.M., Fuks, D., Cowan, J. et al. Total Laparoscopic Pancreaticoduodenectomy with Venous Reconstruction for Pancreatic Head Cancer with Involvement of the Superior Mesenteric Vein–Portal Vein Confluence. Ann Surg Oncol 25, 4035–4036 (2018). https://doi.org/10.1245/s10434-018-6762-5

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  • DOI: https://doi.org/10.1245/s10434-018-6762-5

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