Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours
Purpose Pancreatic malignancy with mesenterico-portal venous involvement can be safely managed with en bloc vein resection with comparable survival outcomes. Non-constructible venous encasement is regarded as criteria of unresectability in pancreatic cancer. In long-standing extra-hepatic venous obs...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2020-11, Vol.405 (7), p.929-937 |
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| creator | Kulkarni, Rugved V. Patil, Vijayraj Bhandare, Manish S. Chaudhari, Vikram A. Shrikhande, Shailesh V. |
| description | Purpose
Pancreatic malignancy with mesenterico-portal venous involvement can be safely managed with en bloc vein resection with comparable survival outcomes. Non-constructible venous encasement is regarded as criteria of unresectability in pancreatic cancer. In long-standing extra-hepatic venous obstruction, hepatopetal blood flow is established by collateralization in the hepatoduodenal and mesenteric region. Their importance in pancreatic malignancies is being recently acknowledged.
Methods
The records of patients undergoing pancreatoduodenectomies were retrospectively evaluated from 2012 to 2019. Pre and intraoperative records of patients undergoing concomitant vein resection were evaluated for the presence of venous collaterals, and its impact on oncological management was studied.
Results
Over a period of 7 years, 947 pancreatoduodenectomies were performed, of which 56 patients underwent concomitant vein resection. Among these, six patients had significant collaterals due to venous obstruction. They had pancreatic adenocarcinoma (2), neuroendocrine tumour (2) and solid pseudopapillary epithelial neoplasm (2) respectively. All these patients successfully underwent pancreatoduodenectomy with vein resection without vascular reconstruction. Superior mesenteric vein (SMV) was resected in four patients, whereas spleno-portal junction was resected in two patients. Dominant collaterals were preserved in all, without compromising oncological safety. Bowel congestion was checked by tolerability to 20-minute mesenteric venous clamping test. There was no major morbidity or hospital mortality following this surgical approach.
Conclusion
We recommend vein resection without reconstruction (VROR) as a novel approach in locally advanced pancreatic tumours (due to non-constructible vein involvement) with significant venous collaterals and emphasize the need to assess venous collateralization pre and intraoperatively. |
| doi_str_mv | 10.1007/s00423-020-01954-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2432860557</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2432860557</sourcerecordid><originalsourceid>FETCH-LOGICAL-c324t-715026eb7c9aa0832e07b660d855487227a475ef2967d95ce827627b741910df3</originalsourceid><addsrcrecordid>eNp9kM1u2zAQhIUiAeq4eYGeeEwOapYUKUq9BUGTBghgwGh8JWhqZSuQSJc_Tf0SfeawUeFjT7uY_WaAnaL4TOELBZA3AYCzqgQGJdBW8JJ_KBaUV6JkXNCz086rj8VFCC8AUMuWL4o_Gxws8RjQxMFZ8jrEvUsxK8bZEH2a5avNerW-Jhk9aGs86ui65Dq02eam41eCv_OhG-yOxD2SkPxuMHok4ZABnybSO09Gl6XxSHT3K4dgd8oaDIlpcsmHT8V5r8eAl__msni-__bj7nv5tHp4vLt9Kk3FeCwlFcBq3ErTag1NxRDktq6ha4TgjWRMai4F9qytZdcKgw2TNZNbyWlLoeurZXE15x68-5kwRDUNweA4aosuBcV4xZoahJAZZTNqvAvBY68Ofpi0PyoK6m_5ai5f5fLVe_mKZ1M1m0KG7Q69esnv2fzS_1xvTICKEw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2432860557</pqid></control><display><type>article</type><title>Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours</title><source>SpringerLink Journals - AutoHoldings</source><creator>Kulkarni, Rugved V. ; Patil, Vijayraj ; Bhandare, Manish S. ; Chaudhari, Vikram A. ; Shrikhande, Shailesh V.</creator><creatorcontrib>Kulkarni, Rugved V. ; Patil, Vijayraj ; Bhandare, Manish S. ; Chaudhari, Vikram A. ; Shrikhande, Shailesh V.</creatorcontrib><description>Purpose
Pancreatic malignancy with mesenterico-portal venous involvement can be safely managed with en bloc vein resection with comparable survival outcomes. Non-constructible venous encasement is regarded as criteria of unresectability in pancreatic cancer. In long-standing extra-hepatic venous obstruction, hepatopetal blood flow is established by collateralization in the hepatoduodenal and mesenteric region. Their importance in pancreatic malignancies is being recently acknowledged.
Methods
The records of patients undergoing pancreatoduodenectomies were retrospectively evaluated from 2012 to 2019. Pre and intraoperative records of patients undergoing concomitant vein resection were evaluated for the presence of venous collaterals, and its impact on oncological management was studied.
Results
Over a period of 7 years, 947 pancreatoduodenectomies were performed, of which 56 patients underwent concomitant vein resection. Among these, six patients had significant collaterals due to venous obstruction. They had pancreatic adenocarcinoma (2), neuroendocrine tumour (2) and solid pseudopapillary epithelial neoplasm (2) respectively. All these patients successfully underwent pancreatoduodenectomy with vein resection without vascular reconstruction. Superior mesenteric vein (SMV) was resected in four patients, whereas spleno-portal junction was resected in two patients. Dominant collaterals were preserved in all, without compromising oncological safety. Bowel congestion was checked by tolerability to 20-minute mesenteric venous clamping test. There was no major morbidity or hospital mortality following this surgical approach.
Conclusion
We recommend vein resection without reconstruction (VROR) as a novel approach in locally advanced pancreatic tumours (due to non-constructible vein involvement) with significant venous collaterals and emphasize the need to assess venous collateralization pre and intraoperatively.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-020-01954-4</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Cardiac Surgery ; General Surgery ; Medicine ; Medicine & Public Health ; Original Article ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2020-11, Vol.405 (7), p.929-937</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c324t-715026eb7c9aa0832e07b660d855487227a475ef2967d95ce827627b741910df3</citedby><cites>FETCH-LOGICAL-c324t-715026eb7c9aa0832e07b660d855487227a475ef2967d95ce827627b741910df3</cites><orcidid>0000-0002-8036-4212</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-020-01954-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-020-01954-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Kulkarni, Rugved V.</creatorcontrib><creatorcontrib>Patil, Vijayraj</creatorcontrib><creatorcontrib>Bhandare, Manish S.</creatorcontrib><creatorcontrib>Chaudhari, Vikram A.</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V.</creatorcontrib><title>Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Pancreatic malignancy with mesenterico-portal venous involvement can be safely managed with en bloc vein resection with comparable survival outcomes. Non-constructible venous encasement is regarded as criteria of unresectability in pancreatic cancer. In long-standing extra-hepatic venous obstruction, hepatopetal blood flow is established by collateralization in the hepatoduodenal and mesenteric region. Their importance in pancreatic malignancies is being recently acknowledged.
Methods
The records of patients undergoing pancreatoduodenectomies were retrospectively evaluated from 2012 to 2019. Pre and intraoperative records of patients undergoing concomitant vein resection were evaluated for the presence of venous collaterals, and its impact on oncological management was studied.
Results
Over a period of 7 years, 947 pancreatoduodenectomies were performed, of which 56 patients underwent concomitant vein resection. Among these, six patients had significant collaterals due to venous obstruction. They had pancreatic adenocarcinoma (2), neuroendocrine tumour (2) and solid pseudopapillary epithelial neoplasm (2) respectively. All these patients successfully underwent pancreatoduodenectomy with vein resection without vascular reconstruction. Superior mesenteric vein (SMV) was resected in four patients, whereas spleno-portal junction was resected in two patients. Dominant collaterals were preserved in all, without compromising oncological safety. Bowel congestion was checked by tolerability to 20-minute mesenteric venous clamping test. There was no major morbidity or hospital mortality following this surgical approach.
Conclusion
We recommend vein resection without reconstruction (VROR) as a novel approach in locally advanced pancreatic tumours (due to non-constructible vein involvement) with significant venous collaterals and emphasize the need to assess venous collateralization pre and intraoperatively.</description><subject>Abdominal Surgery</subject><subject>Cardiac Surgery</subject><subject>General Surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kM1u2zAQhIUiAeq4eYGeeEwOapYUKUq9BUGTBghgwGh8JWhqZSuQSJc_Tf0SfeawUeFjT7uY_WaAnaL4TOELBZA3AYCzqgQGJdBW8JJ_KBaUV6JkXNCz086rj8VFCC8AUMuWL4o_Gxws8RjQxMFZ8jrEvUsxK8bZEH2a5avNerW-Jhk9aGs86ui65Dq02eam41eCv_OhG-yOxD2SkPxuMHok4ZABnybSO09Gl6XxSHT3K4dgd8oaDIlpcsmHT8V5r8eAl__msni-__bj7nv5tHp4vLt9Kk3FeCwlFcBq3ErTag1NxRDktq6ha4TgjWRMai4F9qytZdcKgw2TNZNbyWlLoeurZXE15x68-5kwRDUNweA4aosuBcV4xZoahJAZZTNqvAvBY68Ofpi0PyoK6m_5ai5f5fLVe_mKZ1M1m0KG7Q69esnv2fzS_1xvTICKEw</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Kulkarni, Rugved V.</creator><creator>Patil, Vijayraj</creator><creator>Bhandare, Manish S.</creator><creator>Chaudhari, Vikram A.</creator><creator>Shrikhande, Shailesh V.</creator><general>Springer Berlin Heidelberg</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8036-4212</orcidid></search><sort><creationdate>20201101</creationdate><title>Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours</title><author>Kulkarni, Rugved V. ; Patil, Vijayraj ; Bhandare, Manish S. ; Chaudhari, Vikram A. ; Shrikhande, Shailesh V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-715026eb7c9aa0832e07b660d855487227a475ef2967d95ce827627b741910df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Cardiac Surgery</topic><topic>General Surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kulkarni, Rugved V.</creatorcontrib><creatorcontrib>Patil, Vijayraj</creatorcontrib><creatorcontrib>Bhandare, Manish S.</creatorcontrib><creatorcontrib>Chaudhari, Vikram A.</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V.</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kulkarni, Rugved V.</au><au>Patil, Vijayraj</au><au>Bhandare, Manish S.</au><au>Chaudhari, Vikram A.</au><au>Shrikhande, Shailesh V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><date>2020-11-01</date><risdate>2020</risdate><volume>405</volume><issue>7</issue><spage>929</spage><epage>937</epage><pages>929-937</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Pancreatic malignancy with mesenterico-portal venous involvement can be safely managed with en bloc vein resection with comparable survival outcomes. Non-constructible venous encasement is regarded as criteria of unresectability in pancreatic cancer. In long-standing extra-hepatic venous obstruction, hepatopetal blood flow is established by collateralization in the hepatoduodenal and mesenteric region. Their importance in pancreatic malignancies is being recently acknowledged.
Methods
The records of patients undergoing pancreatoduodenectomies were retrospectively evaluated from 2012 to 2019. Pre and intraoperative records of patients undergoing concomitant vein resection were evaluated for the presence of venous collaterals, and its impact on oncological management was studied.
Results
Over a period of 7 years, 947 pancreatoduodenectomies were performed, of which 56 patients underwent concomitant vein resection. Among these, six patients had significant collaterals due to venous obstruction. They had pancreatic adenocarcinoma (2), neuroendocrine tumour (2) and solid pseudopapillary epithelial neoplasm (2) respectively. All these patients successfully underwent pancreatoduodenectomy with vein resection without vascular reconstruction. Superior mesenteric vein (SMV) was resected in four patients, whereas spleno-portal junction was resected in two patients. Dominant collaterals were preserved in all, without compromising oncological safety. Bowel congestion was checked by tolerability to 20-minute mesenteric venous clamping test. There was no major morbidity or hospital mortality following this surgical approach.
Conclusion
We recommend vein resection without reconstruction (VROR) as a novel approach in locally advanced pancreatic tumours (due to non-constructible vein involvement) with significant venous collaterals and emphasize the need to assess venous collateralization pre and intraoperatively.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00423-020-01954-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8036-4212</orcidid></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Cardiac Surgery General Surgery Medicine Medicine & Public Health Original Article Thoracic Surgery Traumatic Surgery Vascular Surgery |
| title | Vein resection without reconstruction (VROR) in pancreatoduodenectomy: expanding the surgical spectrum for locally advanced pancreatic tumours |
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