Curative intent treatment for pancreatic duct adenocarcinoma invade superior mesenteric vein

Abstract

Pancreatic duct adenocarcinoma (PDAC) accounts for about 85-90% of all solid pancreatic tumors, which is well-known for poor prognosis and high morbidity. Despite the massive advent of chemotherapy and radiotherapy in recent years, surgical removal is still considered the cornerstone management option in this situation. Pancreaticoduodenectomy or Whipple procedure is generally contraindicated in metastasis or tumors that encase more than 50% of vessels. Vascular reconstruction is a state-of-the-art technique which requires the remarkable involvement of vascular experts in the setting of PDAC-invading vessels. In this article, we present an exceptional case of a 38-year-old male patient who underwent radical resection for advanced pancreatic cancer with superior mesenteric vein reconstruction by a great saphenous vein.

Keywords: Pancreatic adenocarcinoma; Superior mesenteric vein; Surgical resection.

Fig. 1

Preoperative abdominal CT scan with contrast enhancement. (A) The axial plane image illustrated the tumor (asterisk) encase the superior mesenteric vein more than 180 degrees (white arrow). The border of this mass with the right colonic mesentery (yellow arrow) and the D2 segment of the duodenum are unclear. (B) The coronal plane image with maximum intensity projection (MIP) reconstruction demonstrated the plastic biliary stent (yellow arrow) and narrowing SMV lumen due to tumoral invasion (white arrow).

Fig. 2

Intraoperative image. (A) The plastic stent was removed from the common bile duct to prepare for resection. (B) The SMV after reconstruction with the anastomosis of collateral venous drainage.