Pancreatic head tumors with portal vein involvement: An alternative surgical approach

Background/Aims: One of the determining factors for the unresectability of pancreatic head tumors is the involvement of the portal venous system. Rece nt reports show that the resection of tumors with portal vein involvement h as similar results to lesions with same stage without portal vein invasion. The aim of this study is to present a technique that allows the resection of portal vein segments without the use of grafts and with a shorter period of intraoperative venous occlusion. Methodology: Fifteen patients with pancreatic head tumors and portal vein i nvolvement were submitted to pancreaticoduodenectomy according to this tech nique. The main feature of the technique is starting the pancreatic dissect ion at the posterior aspect of the head of the pancreas. The superior mesen teric artery is completely dissected from the pancreatic tissues leaving th e section of the pancreas and the resection of the portal vein to the last step. Results: Portal vein flow occlusion did not exceed 10 minutes. There were n o major postoperative complications or mortality. Conclusions: This maneuver allows an easier resection of the mobilized port al vein with a shorter period of venous clamping and reconstruction without the need of venous graft.