Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein

Abstract

We investigated perioperative complications and survival rate in 114 patients with pancreatic cancer who underwent surgical resection between July, 1981 and March, 1992 with an antithrombogenic bypass catheter of the portal vein which we have developed. With this catheter, mesenteric venous blood can be bypassed to the systemic circulation or intrahepatic portal vein to prevent portal congestion or hepatic ischemia during portal obstruction or simultaneous obstruction of the hepatic artery. All the arteries supplying, and veins draining, the pancreas are dissected prior to its manipulation, following which isolated pancreatectomy accompanied by portal vein resection can be performed. Eighty patients (70%) also underwent isolated pancreatectomy. The perioperative death rate was 9.6%, and the main factor contributing to mortality with the bypass method was not portal vein resection, but various postoperative complications, such as insufficiency of the pancreatojejunostomy and thrombosis of the hepatic artery or superior mesenteric artery after resection and reconstruction. We conclude that aggressive surgery with the bypass method increases the operability of pancreatic cancer, although auxiliary therapies combined with radical surgery are necessary to improve the therapeutic outcome for this cancer.