Superior Mesenteric and Portal Vein Reconstruction With Cadaveric Allograft During Pancreatoduodenectomy - A Case Report and Literature Review

Abstract

Background/aim: During the last decade it has been widely demonstrated that venous involvement in pancreatic head cancer is not a sign of poor prognostic, while surgery with curative intent is feasible and with encouraging results. However, the location and extent of venous invasion can occasionally pose serious problems in terms of reconstruction. The aim of the paper is to describe a case in which total superior mesenteric and portal vein resection followed by reconstruction were successfully performed.

Case report: We present the case of a 74-year-old patient submitted to surgery for locally advanced pancreatic cancer invading the portal and superior mesenteric veins. Surgery consisting of pancreatoduodenectomy en bloc with portal vein and superior mesenteric vein resection was performed. The venous axis was reconstructed by using a venous cadaveric allograft originating from the external iliac vein. The postoperative outcome was favorable and the histopathological studies confirmed the local invasion of the resected venous structures.

Conclusion: The cadaveric venous allograft can be safely used in order to reconstruct the venous axis following extended vascular resections for pancreatic cancer.

Keywords: Superior mesenteric vein; cadaveric allograft; pancreatoduodenectomy; portal vein.

Figure 1. The final aspect after pancreatoduodenectomy en bloc with portal and superior mesenteric vein resection and reconstruction using a cadaveric graft consisting of external iliac vein.