Hiroto Ishikawa1*, 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, JapanFulltext PDF
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.
Unresectable locally advanced pancreatic cancer; Left-sided portal hypertension; Right gastroepiploic vein
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. .