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Results of portosystemic shunts during extended pancreatic resections

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Abstract

Purpose

Patients with borderline resectable pancreatic cancer are increasingly explored after neoadjuvant treatment protocols. A complete resection, then, frequently includes the resection of the mesentericoportal axis. Portosystemic shunting for advanced tumours with infiltration of the splenic vein or cavernous transformation of the portal vein can enable complete tumour resection and prevent portovenous congestion of the intestine. The aim of this study was to report the results of this technique for selected patients.

Methods

Patients operated for pancreatic cancer at our department between September 2012 and December 2017 using intraoperative portosystemic shunting were included in this retrospective analysis.

Results

Some 11 patients with pancreatectomy and simultaneous portosystemic shunting were included. The median age was 65.1 years. A distal splenorenal shunt and a temporary mesocaval shunt were accomplished in 5 and 4 cases, respectively. Two patients were operated using persistent mesocaval shunts (from the coronary, splenic or inferior mesenteric veins). The median operating time was 9.43 h. All but one patient were resected with tumour-negative resection margins; 5 patients had relevant complicated postoperative courses. There was one case of in-hospital mortality but no further 30- or 90-day mortality or graft-associated complications. Five patients were alive after a median follow-up of 24.6 months. The median postoperative survival was 12 months.

Conclusion

Portosystemic shunting at the time of extended pancreatectomy is technically challenging but feasible and enables complete tumour resection in cases in which standard vascular reconstruction is limited by cavernous transformation or to prevent sinistral portal hypertension with acceptable morbidity in selected cases. Considering the limited overall survival, the potential individual patient benefit needs to be weighed against the considerable morbidity of advanced tumour resections.

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Author notes

  1. Florian Oehme, Marius Distler, and Benjamin Müssle contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Florian Oehme, Marius Distler, Benjamin Müssle, Christoph Kahlert, Jürgen Weitz & Thilo Welsch

Authors
  1. Florian Oehme
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  2. Marius Distler
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  3. Benjamin Müssle
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  4. Christoph Kahlert
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  5. Jürgen Weitz
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  6. Thilo Welsch
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Contributions

Study conception and design: TW, MD, and JW. Acquisition of data: FO, BM, and CK. Analysis and interpretation of data: FO, BM, CK, TW, MD, and JW. Drafting of the manuscript: FO, BM, CK, TW, MD, and JW. Critical revision of the manuscript: TW, MD, and JW.

Corresponding author

Correspondence to Thilo Welsch.

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Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licencing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The study took place at the Department for Visceral, Thoracic and Vascular Surgery, University Hospital Dresden. Supervision lead surgeons are Prof. Welsch and Prof. Weitz.

None of the information, neither in part nor the complete manuscript, has been published elsewhere. This manuscript is furthermore neither in part nor as complete manuscript under consideration for publication in any other journal.

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Oehme, F., Distler, M., Müssle, B. et al. Results of portosystemic shunts during extended pancreatic resections. Langenbecks Arch Surg 404, 959–966 (2019). https://doi.org/10.1007/s00423-019-01816-8

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  • DOI: https://doi.org/10.1007/s00423-019-01816-8

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