Abstract
Background
Extended resections in the upper GI tract, especially for pancreatic malignancies, can require resection of the hepatic or superior mesenteric artery. Besides venous or allogenous grafting, the splenic artery can be used for reconstruction in both positions.
Purpose
We hereby describe the different technical possibilities of interposition or transposition to use the splenic artery for restoration of arterial perfusion of the liver or the small bowel following resection of the hepatic or superior mesenteric artery, respectively.
Conclusion
The use of the splenic artery is a convenient and appropriate possibility to reconstruct the hepatic or superior mesenteric artery in pancreatic resection with regard to interposition and especially transposition of this vessel. It should be considered in patients suitable to undergo these procedures to extend resectability in pancreatic cancer surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hartwig W, Hackert T, Hinz U et al (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250:81–87
Kim SC, Kim YH, Park KM, Lee YJ (2012) Pancreatic cancer surgery: the state of the art. Curr Drug Targets 13:764–771
Weitz J, Kienle P, Schmidt J, Friess H, Büchler MW (2007) Portal vein resection for advanced pancreatic head cancer. J Am Coll Surg 204:712–716
Adler G, Seufferlein T, Bischoff SC et al (2007) S3-Guidelines “Exocrine pancreatic cancer” 2007. Z Gastroenterol 45:487–523
Mollberg N, Rahbari NN, Koch M et al (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254:882–893
Amano H, Miura F, Toyota N et al (2009) Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer. J Hepato-Biliary-Pancreat Surg 16:777–780
Bockhorn M, Burdelski C, Bogoevski D, Sgourakis G, Yekebas EF, Izbicki JR (2011) Arterial en bloc resection for pancreatic carcinoma. Br J Surg 98:86–92
Ielpo B, Ferri V, Caruso R et al (2013) Alternative arterial reconstruction after extended pancreatectomy. Case report and some considerations of locally advanced pancreatic cancer. JOP 14:432–437
Seelig MH, Belyaev O, Uhl W (2010) Reconstruction of the common hepatic artery at the time of total pancreatectomy using a splenohepatic bypass. J Gastrointest Surg 14:913–915
Amano H, Miura F, Toyota N et al (2009) Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepato-Biliary-Pancreat Surg 16:850–857
Johnston PC, Guercio AF, Johnson SP, Hollis HW Jr, Pratt CF, Rehring TF (2012) Endovascular recanalization of the superior mesenteric artery in the context of mesenteric bypass graft infection. J Vasc Surg 57(5):1398–1400
Weitz J, Rahbari N, Koch M et al (2010) The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg 201:e1–e4
Hackert T, Werner J, Weitz J et al (2010) Uncinate process first—a novel approach for pancreatic head resection. Langenbeck’s Arch Surg 395(8):1161–1164
Sakuraba M, Miyamoto S, Nagamatsu S, Kayano S, Taji M, Kinoshita T, Kosuge T, Kimata Y (2012) Hepatic artery reconstruction following ablative surgery for hepatobiliary and pancreatic malignancies. Eur J Surg Oncol 38(7):580–585
Strobel O, Berens V, Hinz U, Hartwig W, Hackert T, Bergmann F, Debus J, Jäger D, Büchler MW, Werner J (2012) Resection after neoadjuvant therapy for locally advanced, “unresectable” pancreatic cancer. Surgery 152(3 Suppl 1):S33–S42
Katz MH, Lee JE, Pisters PW, Skoracki R, Tamm E, Fleming JB (2012) Retroperitoneal dissection in patients with borderline resectable pancreatic cancer: operative principles and techniques. J Am Coll Surg 215:e11–e18
Gaujoux S, Sauvanet A, Vullierme MP, Cortes A, Dokmak S, Sibert A, Vilgrain V, Belghiti J (2009) Ischemic complications after pancreaticoduodenectomy: incidence, prevention, and management. Ann Surg 249:111–117
Hackert T, Stampfl U, Schulz H, Strobel O, Büchler MW, Werner J (2011) Clinical significance of liver ischaemia after pancreatic resection. Br J Surg 98:1760–1765
Sakorafas GH, Sarr MG, Peros G (2008) Celiac artery stenosis: an underappreciated and unpleasant surprise in patients undergoing pancreaticoduodenectomy. J Am Coll Surg 206:349–356
Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T (2003) Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body. Langenbeck’s Arch Surg 388:101–106
Strasberg SM, Fields R (2012) Left-sided pancreatic cancer: distal pancreatectomy and its variants: radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection. Cancer J 18:562–570
Smoot RL, Donohue JH (2012) Modified Appleby procedure for resection of tumors of the pancreatic body and tail with celiac axis involvement. J Gastrointest Surg 16:2167–2169
Halazun KJ, Kotru A, Menon KV, Patel J, Prasad KR (2006) Stenting of coeliac axis stenosis facilitates pancreatectomy. Eur J Surg Oncol 32:811–812
Kitagawa M, Ikoma H, Ochiai T et al (2012) Total pancreatectomy for pancreatic carcinoma: evaluation of safety and efficacy. Hepatogastroenterology 59:907–910
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hackert, T., Weitz, J. & Büchler, M.W. Splenic artery use for arterial reconstruction in pancreatic surgery. Langenbecks Arch Surg 399, 667–671 (2014). https://doi.org/10.1007/s00423-014-1200-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-014-1200-z