Outcomes from mesenteric-portal axis resection during pancreatectomy

Background

Due to their complexity and risks, mesenteric-portal axis resection andreconstruction during the pancreatectomy procedure were not recommended back inthe early nineties. However, as per technical improvements and the reduction inmorbidity and mortality rates, they have been routinely indicated in large medicalcenters.

Aim

To show results from cases of patients subjected to mesenteric-portal axisresection during pancreatectomy.

Method

Patients subjected to mesenteric-portal axis resection during pancreatectomy wereprospectively and consecutively assessed. The procedure was indicated according toanatomical criteria defined by imaging exams or intraoperative assessment.

Results

Ten patients, half of them were male, with mean age of 55.7 years (40-76) wereincluded. The most frequent underlying diseases were pancreatic adenocarcinoma andFrantz tumor. The circumferential resection of the portal vein associated with thesuperior mesenteric vein with splenic vein ligature (4 cases=40%) and the primaryanastomosis of the vascular stumps (5 cases=50%) were, respectively, the mostperformed types of vascular resection and reconstruction. Surgery time ranged from480 to 600 minutes (average=556 minutes) and postoperative hospitalization timeranged from 9 to 114 days (average=34.8 days). Morbidity rate was 60%, andclinical pancreatic fistula (grade B and C) was the most common complication (3cases=30%). Mortality rate was 10% (1 case).

Conclusion

Mesenteric-portal axis resection is a valid technical procedure. It should betaken into account after a clinical assessment that included not only thepatients'' clinical condition but also the technical and anatomical conditions ofthe mesenteric-portal axis tumor infiltration as well as life expectancy based onthe patient''s cancer prognosis.