Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):419-424. 10.14701/ahbps.2018.22.4.419.

Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure?

Affiliations
  • 1Department of Education and Training, Severance Hospital, Seoul, Korea.
  • 2Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea. cmkang@yuhs.ac
  • 3Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.

Abstract

The feasibility of laparoscopic pancreaticoduodenectomy (LPD) in the treatment of pancreatic cancer is still disputed. However, advances in surgical technique and accumulating experience have led to the use of LPD with combined vascular resection and reconstruction as a safe and feasible procedure, especially in pancreatic cancer with major vascular involvement. A 64-year-old woman presented with obstructive jaundice secondary to pancreatic head cancer. Contrast abdominopelvic computed tomography revealed a pancreatic head tumor measuring approximately 22 mm in diameter that was abutting the first jejunal branch of the superior mesenteric vein at an angle of < 180°. The patient underwent LPD, which failed to resect the pancreatic head tumor invading the superior mesenteric vein. Consequently, segmental resection of the confluence of the superior mesenteric vein, splenic vein, and portal vein (SMV/SV/PV) was completely performed in laparoscopic approach without complication. The patient recovered without any event and was discharged on postoperative day 9. LPD combined with vascular resection and reconstruction is feasible in cases involving major blood vessels. Further surgical expertise and education are required before LPD can be used as a standard procedure.

Keyword

Laparoscopic pancreaticoduodenectomy; Minimal invasive surgery; Vascular resection; Vascular reconsruction

MeSH Terms

Blood Vessels
Education
Female
Head and Neck Neoplasms*
Head*
Humans
Jaundice, Obstructive
Mesenteric Veins
Middle Aged
Pancreatic Neoplasms
Pancreaticoduodenectomy*
Portal Vein
Splenic Vein
Veins*
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