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Case Reports
. 2013 Apr 28;19(16):2569-73.
doi: 10.3748/wjg.v19.i16.2569.

Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer

Yosuke Tsuruga  1 , Hirofumi Kamachi, Kenji Wakayama, Tatsuhiko Kakisaka, Hideki Yokoo, Toshiya Kamiyama, Akinobu Taketomi
Affiliations
Case Reports

Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer

Yosuke Tsuruga et al. World J Gastroenterol. .

Abstract

Extrahepatic portal vein (PV) stenosis has various causes, such as tumor encasement, pancreatitis and as a post-surgical complication. With regard to post-pancreaticoduodenectomy, intraoperative radiation therapy with/without PV resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed NACRT in 18 patients with borderline resectable pancreatic cancer since 2005. Of the 15 patients who completed NACRT, nine had undergone pancreatectomy. Combined portal resection was performed in eight of the nine patients. We report here three patients with PV stenosis, and thus the ratio of post-operative PV stenosis in patients with PV resection following NACRT is 37.5% in this series. We encountered no case of PV stenosis among 22 patients operated with PV resection for pancreatobiliary cancer without NACRT during the same period. A relationship between PV stenosis and NACRT is suspected, but further investigation is required to determine whether NACRT has relevance to PV stenosis.

Keywords: Expandable metallic stent; Neoadjuvant chemoradiation therapy; Pancreatectomy; Pancreatic cancer; Portal vein stenosis.

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Figures

Figure 1
Figure 1
Computed tomography showed short segmental stenosis of the portal vein in the region of the anastomosis, severe ascites, and liver atrophy. A, B: Computed tomography (CT) scan shows severe ascites and liver atrophy (arrow) (A), and stenosis of the portal vein (arrow) behind the superior mesenteric artery (B); C: The image of the 3D reconstruction of the portal vein shows short segmental stenosis in the region of the anastomosis (arrow).
Figure 2
Figure 2
Computed tomography scan 3 mo after the expandable metallic stent placement. A: Shows that the ascites decreased and the liver atrophy improved; B: The stent placed in the portal vein remained patent.
Figure 3
Figure 3
Computed tomography showed short segmental stenosis of the portal vein in the region of the anastomosis, collateral circulation through the cavernous transformation of the pancreatic head, severe ascites, and thickness of the intestinal wall. A: Computed tomography scan showing severe portal vein stenosis (arrow) in the region of the anastomosis; B: Multiplanar reconstruction revealed the collateral circulation through the cavernous transformation of the pancreatic head (arrow), severe ascites and thickness of the intestinal wall.
Figure 4
Figure 4
Percutaneous transhepatic direct portography showing short segmental stenosis of the portal vein in the region of the anastomosis. A: Collateral circulation of the pancreatic head; B: After the expandable metallic stent (EMS) placement, the stenosis was improved, and the collateral circulation disappeared; C: The blood flow of the umbilical portion of the left portal vein was unclear; D: The stenosis was improved, and the blood flow of the umbilical portion became clear after the EMS placement.
See this image and copyright information in PMC

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