A. Horiguchi et al., Portal vein resection without reconstruction during Appleby operation in apatient with pancreatic body carcinoma with cavernous transformation, HEP-GASTRO, 46(28), 1999, pp. 2628-2630
The prognosis of pancreatic body carcinoma has been poor due to cancerous i
nvasion of major vessels. Resection of the involved vessels may improve res
ectability and prognosis. We report a patient who had a pancreatic body car
cinoma with cavernous transformation of the portal vein, in whom the portal
vein was resected without reconstruction during an Appleby operation. A 67
year-old man was admitted for evaluation of back pain. Enhanced computed t
omography showed no main trunk of the portal vein but a developed collatera
l circulation. Celiac angiography revealed encasement of the common hepatic
, splenic and celiac artery,venous angiography revealed obstruction of the
portal and splenic veins with cavernous transformation surrounding these ve
ins. Pre-operative diagnosis was carcinoma in the. pancreatic body, which i
nvaded the portal vein, the celiac and common hepatic arteries. The Appleby
operation combined with resection of the portal vein without reconstructio
n could be performed, by preserving collateral vessels and monitoring hepat
ic venous oxygen saturation (ShvO(2)) to prevent hepatic ischemia caused by
occlusion of the portal vein. The post-operative course was uneventful.