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Management of the splenic vein during a pancreaticoduodenectomy with venous resection for malignancy

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Abstract

Nowadays, pancreaticoduodenectomies (PD) with an “en-bloc” resection of the spleno-mesenterico-portal (SMP) venous axis are safely performed at tertiary centers for patients presenting venous invasion. However, for tumors infiltrating the SMP confluence optimal management of the splenic vein (SV) remains a matter of debate. Simple SV ligation has been associated with the development of sinistral portal hypertension, gastrointestinal bleeding and hypersplenism over the long term. To avoid these complications, reconstructive methods such as the direct implantation of the SV into a SMP “neoconfluence”, the inferior mesenteric vein-SV anastomosis and the distal spleno-renal shunt have been reported. This article summarizes the different technical solutions available and the current evidence supporting the optimal management of the SV stump during a “safe” radical PD for pancreatic cancer. Technical issues, advantages as well as drawbacks of the different techniques, are discussed.

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    Authors and Affiliations

    1. Hepato–Pancreato–Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France

      Pietro Addeo, Gennaro Nappo, Emanuele Felli, Constantin Oncioiu, François Faitot & Philippe Bachellier

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    1. Pietro Addeo
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    2. Gennaro Nappo
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    3. Emanuele Felli
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    4. Constantin Oncioiu
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    5. François Faitot
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    6. Philippe Bachellier
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    Corresponding author

    Correspondence to Philippe Bachellier.

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    All the authors have no conflict of interest to disclose.

    Research involving human participants and/or animals

    This technical review article is compliant with ethical standard for research involving human participants.

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    Informed consent was obtained from patients undergoing venous resection depicted in the operative pictures presented.

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    E. Felli and G. Nappo equally contributed to this work.

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    Addeo, P., Nappo, G., Felli, E. et al. Management of the splenic vein during a pancreaticoduodenectomy with venous resection for malignancy. Updates Surg 68, 241–246 (2016). https://doi.org/10.1007/s13304-016-0396-6

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    • DOI: https://doi.org/10.1007/s13304-016-0396-6

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