Pancreatoduodenectomy with En Bloc Superior Mesenteric Artery and Vein Resection Under Temporary Mesenterico-Portal Venous Shunt: The Strasbourg Technique.

Fiche publication

Date publication

avril 2025

Journal

Annals of surgical oncology

Auteurs

Membres identifiés du Cancéropôle Est :
Pr BACHELLIER Philippe

Tous les auteurs :
Bachellier P, de Mathelin P, Addeo P

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/40169482

Résumé

Pancreatectomies with superior mesenteric artery (SMA) resection are technically challenging. With the advent of FOLFIRNOX chemotherapy, resection of the SMA is performed in selected patients with locally advanced pancreatic cancer (LAPC), in centers of excellence by highly skilled pancreatic-vascular surgeons treating a large volume of LAPCs. METHODS: The patient was a 64-year-old female with an LAPC treated with 11 cycles of FOLFIRINOX induction chemotherapy. The SMA, the superior mesenteric vein (SMV), and a replaced right hepatic artery (r-RHA) were encased. A temporary mesenterico-portal shunt (TMPS), using a 25 cm Goretex tube between the origin of the SMV and the right side of the portal vein, was used. This TMPS (1) lessens portal hypertension in case of SMV obstruction; (2) maintains adequate liver venous perfusion during dissection; (3) gives the mesentery enough mobility to avoid graft for SMA resection; and (4) avoids simultaneous venous and arterial clamping. A mesenteric approach was performed to isolate the SMA. Upon heparin bolus, the r-RHA was re-implanted on the gastroduodenal artery stump, the SMA on the aorta, the SMV on the portal vein, and the splenic vein on the left renal vein.