Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):419-424. 10.14701/ahbps.2018.22.4.419.

Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure?

• Park H
• Kang I
• Kang CM

• KMID: 2427376
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.419

Abstract

The feasibility of laparoscopic pancreaticoduodenectomy (LPD) in the treatment of pancreatic cancer is still disputed. However, advances in surgical technique and accumulating experience have led to the use of LPD with combined vascular resection and reconstruction as a safe and feasible procedure, especially in pancreatic cancer with major vascular involvement. A 64-year-old woman presented with obstructive jaundice secondary to pancreatic head cancer. Contrast abdominopelvic computed tomography revealed a pancreatic head tumor measuring approximately 22 mm in diameter that was abutting the first jejunal branch of the superior mesenteric vein at an angle of < 180°. The patient underwent LPD, which failed to resect the pancreatic head tumor invading the superior mesenteric vein. Consequently, segmental resection of the confluence of the superior mesenteric vein, splenic vein, and portal vein (SMV/SV/PV) was completely performed in laparoscopic approach without complication. The patient recovered without any event and was discharged on postoperative day 9. LPD combined with vascular resection and reconstruction is feasible in cases involving major blood vessels. Further surgical expertise and education are required before LPD can be used as a standard procedure.

Keyword

Laparoscopic pancreaticoduodenectomy; Minimal invasive surgery; Vascular resection; Vascular reconsruction

MeSH Terms

Blood Vessels
Education
Female
Head and Neck Neoplasms*
Head*
Humans
Jaundice, Obstructive
Mesenteric Veins
Middle Aged
Pancreatic Neoplasms
Pancreaticoduodenectomy*
Portal Vein
Splenic Vein
Veins*

Figure

• 

  Fig. 1 Preoperative imaging. (A) Magnetic resonance cholangiopancreatoscopy revealed a pancreatic head mass leading to the bile duct, as well as pancreatic duct dilatation. (B) Contrast abdominopelvic computed tomography revealed a pancreatic head tumor measuring around 22 mm in diameter that was abutting the 1st (jejunal) branch of the superior mesenteric vein at an angle of <180°. (C) Endoscopic ultrasonography revealed a solid mass in the pancreatic head measuring 26.1 mm in diameter, with a suspicious duodenal wall invasion. (D) Positron-emission tomography–computed tomography demonstrated significant fluorodeoxyglucose uptake in the pancreatic head lesion, suggesting malignancy (D).

• 

  Fig. 2 Port placement for laparoscopic pancreaticoduodenectomy.

• 

  Fig. 3 Intraoperative and postoperative findings. Ao, aorta; BD, bile duct; CHA, common hepatic artery; LRV, left renal vein; PV, portal vein; RRA, right renal artery; SMA, superior mesenteric artery; SMV, superior mesenteric vein. Labels: pancreatic duct (short white arrow); anastomosis site (multiple small white arrow); vascular patency confirmed (large white arrow head).

Reference

1. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it's time to randomize. Surgery. 2015; 157:45–55. PMID: 25482464.

2. Yan JF, Kuang TT, Ji DY, Xu XW, Wang DS, Zhang RC, et al. Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study. J Zhejiang Univ Sci B. 2015; 16:573–579. PMID: 26160714.

3. Nakamura M, Nakashima H. Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 2013; 20:421–428. PMID: 23224732.

4. Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas. 2012; 41:993–1000. PMID: 22836858.

5. Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM. Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg. 2012; 35:1–8. PMID: 22726557.

6. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001; 182:120–129. PMID: 11574081.

7. Chua TC, Saxena A. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010; 14:1442–1452. PMID: 20379794.

8. Menon VG, Puri VC, Annamalai AA, Tuli R, Nissen NN. Outcomes of vascular resection in pancreaticoduodenectomy: single-surgeon experience. Am Surg. 2013; 79:1064–1067. PMID: 24160800.

9. Siriwardana HP, Siriwardena AK. Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006; 93:662–673. PMID: 16703621.

10. Yu XZ, Li J, Fu DL, Di Y, Yang F, Hao SJ, et al. Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis. Eur J Surg Oncol. 2014; 40:371–378. PMID: 24560302.

11. Cai Y, Gao P, Li Y, Wang X, Peng B. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc. 2018; 32:4209–4215. PMID: 29602996.

12. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015; 19:189–194. PMID: 25274069.

13. Dokmak S, Aussilhou B, Calmels M, Maghrebi H, Ftériche FS, Soubrane O, et al. Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament. Surg Endosc. 2018; 32:3256–3261. PMID: 29349542.

14. Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011; 13:454–458. PMID: 21689228.

15. Khatkov IE, Izrailov RE, Khisamov AA, Tyutyunnik PS, Fingerhut A. Superior mesenteric-portal vein resection during laparoscopic pancreatoduodenectomy. Surg Endosc. 2017; 31:1488–1495. PMID: 27444832.

16. Palanisamy S, Deuri B, Naidu SB, Vaiyapurigoundar Palanisamy N, Natesan AV, Palanivelu PR, et al. Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: one step forward. Asian J Endosc Surg. 2015; 8:468–472. PMID: 26708588.

17. Awad ZT. Totally laparoscopic pancreaticoduodenectomy for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol. 2014; 21:3439. PMID: 24841345.

18. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014; 260:633–638. PMID: 25203880.

19. Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ. Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc. 2013; 27:4518–4523. PMID: 23943116.

20. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012; 215:810–819. PMID: 22999327.

21. Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc. 2015; 29:9–23. PMID: 25125092.

22. Hakeem AR, Verbeke CS, Cairns A, Aldouri A, Smith AM, Menon KV. A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol. Hepatobiliary Pancreat Dis Int. 2014; 13:435–441. PMID: 25100130.

23. Langan RC, Graham JA, Chin AB, Rubinstein AJ, Oza K, Nusbaum JA, et al. Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery. 2014; 156:379–384. PMID: 24680859.

24. Frazee RC, Roberts JW, Symmonds R, Snyder SK, Hendricks J, Smith R, et al. What are the contraindications for laparoscopic cholecystectomy? Am J Surg. 1992; 164:491–494. PMID: 1443375.

25. Fontes PR, Nectoux M, Eilers RJ, Chem EM, Riedner CE. Is acute cholecystitis a contraindication for laparoscopic cholecystectomy? Int Surg. 1998; 83:28–30. PMID: 9706512.

26. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997; 21:540–545. PMID: 9204745.

27. Cirocchi R, Del Sol A, Morelli U, Cattorini L, La Mura F, Napolitano V, et al. [Laparoscopic cholecystectomy for acute cholecystitis]. G Chir. 2008; 29:305–311. Italian. PMID: 18544271.

28. Stanišić V, Bakić M, Magdelinić M, Kolašinac H, Babić I. [Laparoscopic cholecystectomy of acute cholecystitis]. Med Pregl. 2010; 63:404–408. Croatian. PMID: 21186555.

29. Shinke G, Noda T, Hatano H, Shimizu J, Hirota M, Takata A, et al. Feasibility and safety of urgent laparoscopic cholecystectomy for acute cholecystitis after 4 days from symptom onset. J Gastrointest Surg. 2015; 19:1787–1793. PMID: 26129654.

30. Liao CH, Wu YT, Liu YY, Wang SY, Kang SC, Yeh CN, et al. Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy. World J Surg. 2016; 40:1218–1225. PMID: 26830906.