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24.08.2019 | Original Article

Results of portosystemic shunts during extended pancreatic resections

verfasst von: Florian Oehme, Marius Distler, Benjamin Müssle, Christoph Kahlert, Jürgen Weitz, Thilo Welsch

Erschienen in: Langenbeck's Archives of Surgery

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Abstract

Purpose

Patients with borderline resectable pancreatic cancer are increasingly explored after neoadjuvant treatment protocols. A complete resection, then, frequently includes the resection of the mesentericoportal axis. Portosystemic shunting for advanced tumours with infiltration of the splenic vein or cavernous transformation of the portal vein can enable complete tumour resection and prevent portovenous congestion of the intestine. The aim of this study was to report the results of this technique for selected patients.

Methods

Patients operated for pancreatic cancer at our department between September 2012 and December 2017 using intraoperative portosystemic shunting were included in this retrospective analysis.

Results

Some 11 patients with pancreatectomy and simultaneous portosystemic shunting were included. The median age was 65.1 years. A distal splenorenal shunt and a temporary mesocaval shunt were accomplished in 5 and 4 cases, respectively. Two patients were operated using persistent mesocaval shunts (from the coronary, splenic or inferior mesenteric veins). The median operating time was 9.43 h. All but one patient were resected with tumour-negative resection margins; 5 patients had relevant complicated postoperative courses. There was one case of in-hospital mortality but no further 30- or 90-day mortality or graft-associated complications. Five patients were alive after a median follow-up of 24.6 months. The median postoperative survival was 12 months.

Conclusion

Portosystemic shunting at the time of extended pancreatectomy is technically challenging but feasible and enables complete tumour resection in cases in which standard vascular reconstruction is limited by cavernous transformation or to prevent sinistral portal hypertension with acceptable morbidity in selected cases. Considering the limited overall survival, the potential individual patient benefit needs to be weighed against the considerable morbidity of advanced tumour resections.
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Metadaten
Titel
Results of portosystemic shunts during extended pancreatic resections
verfasst von
Florian Oehme
Marius Distler
Benjamin Müssle
Christoph Kahlert
Jürgen Weitz
Thilo Welsch
Publikationsdatum
24.08.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-019-01816-8

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