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Review
. 2024 Jun 27;16(13):2361.
doi: 10.3390/cancers16132361.

Use of Vascular Shunt at the Time of Pancreatectomy with Venous Resection: A Systematic Review

Annarita Libia  1 , Tiziana Marchese  1 , Stefano D'Ugo  1 , Prisco Piscitelli  2   3 , Fabio Castellana  4 , Maria Lisa Clodoveo  4 , Roberta Zupo  4 , Marcello Giuseppe Spampinato  1
Affiliations
Review

Use of Vascular Shunt at the Time of Pancreatectomy with Venous Resection: A Systematic Review

Annarita Libia et al. Cancers (Basel). .

Abstract

Background: The rising diffusion of vascular resections during complex pancreatectomy for malignancy, for both oncological and technical matters, brought with it the use of vascular shunts, either temporary or definitive, to prevent bowel congestion and liver ischemia. This study aimed to systematically review the literature on the technical feasibility of vascular shunts during advanced pancreatic surgery, analyzing intraoperative and postoperative outcomes.

Methods: A systematic literature search was performed on PubMed, Scopus, Web of Science, and the Cochrane Library Central, according to PRISMA guidelines. Studies published before 2006 were excluded, considering the lack of a standardized definition of locally advanced pancreatic cancer. The main outcomes evaluated were the overall complication rate and shunt patency.

Results: Among 789 papers retrieved from the database search, only five fulfilled the inclusion criteria and were included in the review, amounting to a total of 145 patients undergoing a shunt creation at the time of pancreatectomy. Pancreatic adenocarcinoma (PDAC) was found to be the most common diagnosis and pancreaticoduodenectomy was the main surgical procedure, accounting for 88% and 83% of the overall cohort, respectively. The distal splenorenal shunt was the most performed. Overall, 44 out of 145 patients (30%) experienced postoperative complications; the long-term patency of definitive shunts was 83% (110 out of 120 patients).

Conclusions: An increasing number of patients with borderline resectable or locally advanced PDAC are becoming amenable to resection and shunt creation may facilitate vascular resection with clear margins, becoming a valid tool of modern pancreatic surgery.

Keywords: pancreatectomy; pancreatic ductal carcinoma; systematic review; vascular resection; vascular shunt.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mesocaval shunt (MCS).
Figure 2
Figure 2
Mesoportal Shunt (MPS).
Figure 3
Figure 3
Distal spleno-renal shunt (DSRS).
Figure 4
Figure 4
PRISMA 2020 flow diagram of the screening process.
Figure 5
Figure 5
Risk of bias assessment according to Newcastle and Ottawa scale [6,11,12,13,14].
Figure 6
Figure 6
Risk of bias of selected studies across domains.
See this image and copyright information in PMC

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