Outcomes from mesenteric-portal axis resection during
pancreatectomy |
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Authors: | Enio Campos AMICO José Roberto ALVES Samir Assi JO?O Ricardo Wagner da Costa MOREIRA José Linhares da SILVA NETO Joafran Alexandre Costa de MEDEIROS |
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Institution: | From the 1.Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil;2.Liga Norte-Riograndense contra o Câncer, Natal, RN, Brazil |
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Abstract: | BackgroundDue to their complexity and risks, mesenteric-portal axis resection and
reconstruction during the pancreatectomy procedure were not recommended back in
the early nineties. However, as per technical improvements and the reduction in
morbidity and mortality rates, they have been routinely indicated in large medical
centers.AimTo show results from cases of patients subjected to mesenteric-portal axis
resection during pancreatectomy.MethodPatients subjected to mesenteric-portal axis resection during pancreatectomy were
prospectively and consecutively assessed. The procedure was indicated according to
anatomical criteria defined by imaging exams or intraoperative assessment.ResultsTen patients, half of them were male, with mean age of 55.7 years (40-76) were
included. The most frequent underlying diseases were pancreatic adenocarcinoma and
Frantz tumor. The circumferential resection of the portal vein associated with the
superior mesenteric vein with splenic vein ligature (4 cases=40%) and the primary
anastomosis of the vascular stumps (5 cases=50%) were, respectively, the most
performed types of vascular resection and reconstruction. Surgery time ranged from
480 to 600 minutes (average=556 minutes) and postoperative hospitalization time
ranged from 9 to 114 days (average=34.8 days). Morbidity rate was 60%, and
clinical pancreatic fistula (grade B and C) was the most common complication (3
cases=30%). Mortality rate was 10% (1 case).ConclusionMesenteric-portal axis resection is a valid technical procedure. It should be
taken into account after a clinical assessment that included not only the
patients'' clinical condition but also the technical and anatomical conditions of
the mesenteric-portal axis tumor infiltration as well as life expectancy based on
the patient''s cancer prognosis. |
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Keywords: | Vascular surgical procedures Pancreaticoduodenectomy Pancreatic Neoplasms |
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