Safety and effectiveness of splenic vein to inferior mesenteric vein anastomosis during pancreaticoduodenectomy: comment on 'Splenic vein-inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection'.

摘要

Radical resection is currently regarded as the standard operation for pancreatic cancer. Unfortunately, in 10% to 20% of patients, extension beyond the pancreas to involve contiguous major vascular structures limits respectability and possible cure. Extending the scope of the operation to include segments of the PV and/or SMV has proved to be safe, and immediate reconstruction is feasible using well-established vascular surgical techniques. In some instances, resection of the SV-mesenteric vein confluence including the IMV is necessary to achieve an R0 resection. If the SV-IMV confluence remains intact, venous outflow from the spleen is preserved, thereby avoiding the potential development of left-sided portal hypertension and hypertensive gastropathy and/or gastric variceal hemorrhage.