2-STEP PORTAL BYPASS TO RECONSTRUCT AN INVADED SUPERIOR MESENTERIC VEIN IN PANCREATIC-CANCER

Advanced cancer of the pancreatic head, especially in its caudal porti on, has a limited surgical resectability due to its frequent invasion to the superior mesenteric vein (SMV). A patient with advanced carcino ma of the pancreatic head with vascular invasion to the major bifurcat ion of the SMV, underwent a pancreaticoduodenectomy under a two-step p assive bypass of the portal flow. The marginal colic veins were dilate d and formed a long collateral route to the inferior mesenteric vein a nd the splenic vein due to stenosis of the SMV. The venous flow in thi s vein was then easily interrupted with the surgical manipulation of t he transverse colon. The first passive bypass was thus inserted into t he accessory right colic vein to preserve the venous return from both the small intestine and the colon, and also to enable surgical dissect ion of the invaded SMV itself. After a thorough dissection of the inva ded SMV, a second bypass was inserted into the main trunk of the SMV t hrough the dissected vascular stump. Subsequently the passive bypass w as maintained until the portal reconstruction with an interposition of the left common iliac vein could be performed. The patient recovered well from the surgery without any complications throughout the postope rative course. In summary, the two-step portal bypass describes, is th us considered a stable and safe procedure for the reconstruction of th e superior mesenteric vein, during pancreatoduodenectomy for advanced carcinoma of the pancreatic head.