Portal vein resection without reconstruction during Appleby operation in apatient with pancreatic body carcinoma with cavernous transformation

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.