[Preparation of an antithrombogenic bypass-catheter of the portal vein and its application to extended radical surgery in pancreatic cancer]

Abstract

The curative resectability of pancreatic cancer has been considered to be extremely low. One of the reasons for this is invasion of the pancreatic cancer cells into the portal vein, and resection of the portal vein in the usual manner would bring create various problems following acute portal vein occlusion. Sudden occlusion of the portal vein has been shown to cause profound and fatal shock in animal experiments. Now, however, with our newly developed procedure of bypassing the portal blood into the systemic circulation or intrahepatic portal vein using an antithrombogenic bypass-catheter, made from heparinized hydrophilic polymer (Toray, Anthron), combined resection of the portal vein can be performed with safety and ease. Using the catheter-bypass method, 55 pancreatectomies accompanied by portal vein resection have been safely performed, mostly in patients with pancreatic cancer. Occlusion time of the portal vein ranged from 20-302 minutes (mean, 94 minutes). No side effects of the catheter were observed. The rate of occurrence of postoperative thrombosis of the portal vein was 1.8% (1/55) and operative mortality was 7.3% (4/55). Resectability rate for pancreatic cancer was 11.2% (5/42) between 1971 and 1980, but this has been remarkably improved to over 60% (53/87) in the period between 1981 and August 1986 by the application of the catheter-bypass method. This method is recommended not only for pancreatic cancer operations but also for hepatobiliary surgery.