Ann Surg Case Rep | Volume 2, Issue 2 | Case Report | Open Access

Preservation of Right Gastroepiploic Vein to Lessen Left-Sided Portal Hypertension after Conversion Pancreaticoduodenectomy with Concomitant Vascular Resection after Chemotherapy for a Locally Advanced Pancreatic Cancer

Hiroto Ishikawa^1*, Jyun Okadome¹, Midori Yamamura¹, Ayako Nakame¹, Yoshiyuki Shirouzu¹, Daisuke Muroya¹, Satoshi Kuratsu¹, Kazutaka Kadoya¹, Yukiya Kishimoto¹, Masayuki Okabe¹, Tomokazu Kosuga¹, Teiji Okazaki¹, Keiichiro Tayama¹, Kenichi Kosuga¹, Hirohisa Yano², Koji Okuda², Hiroyuki Tanaka² and Yoshito Akagi²

¹Department of Surgery, Munakata Suikokai General Hospital, Japan²Department of Pathology, Kurume University School of Medicine, Japan³Department of Surgery, Kurume University School of Medicine, Japan

^*Correspondance to: Hiroto Ishikawa 

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Abstract

More than 30% to 40% of all cases of pancreatic cancer are initially considered unresectable. Unresectable Locally Advanced Pancreatic Cancer (UR-LAPC) patients have a poor prognosis worldwide, and almost all these patients have extensive vascular involvement and perineural invasion at initial diagnosis that precludes surgical intervention. Recently, some reports have revealed that induction chemotherapy followed by conversion surgery for UR-LAPC may be more efficacious. In locally advanced pancreatic head and body cancer, Portal Vein (PV) and Superior Mesenteric Vein (SMV) is frequently involved because of the vein’s anatomical location. In Pancreaticoduodenectomy (PD) combined with vascular resection may cause secondary Left sided Portal Hypertension (LPH). We report a case of successful conversion surgery for an initial UR-LAPC after induction GEM + nab-PTX chemotherapy. In PD with resection of PV, SMV, Splenic Vein (SV), inferior mesenteric vein (IMV) and Left Gastric Vein (LGV) confluence may cause secondary LPH, but concomitant preservation of Right Gastroepiploic Vein (RGEPV) may attenuate secondary LPH.

Keywords:

Unresectable locally advanced pancreatic cancer; Left-sided portal hypertension; Right gastroepiploic vein

Citation:

Ishikawa H, Okadome J, Yamamura M, Nakame A, Shirouzu Y, Muroya D, et al. Preservation of Right Gastroepiploic Vein to Lessen Left-Sided Portal Hypertension after Conversion Pancreaticoduodenectomy with Concomitant Vascular Resection after Chemotherapy for a Locally Advanced Pancreatic Cancer. Ann Surg Case Rep. 2019; 2(2): 1017. .