Journal
CANCERS
Volume 13, Issue 21, Pages -Publisher
MDPI
DOI: 10.3390/cancers13215334
Keywords
sinistral portal hypertension; pancreatic cancer; pancreaticoduodenectomy; splenic vein ligation/resection; gastrointestinal varices; gastrointestinal bleeding
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In pancreaticoduodenectomy (PD) for pancreatic cancer, extensive portal vein resection may sometimes be necessary for curative resection, including porto-mesenterico-splenic confluence (PMSC). However, long-term survival patients may develop sinistral portal hypertension as a late-onset postoperative complication.
To achieve curative resection for pancreatic cancer during pancreaticoduodenectomy (PD), extensive portal vein (PV) resection, including porto-mesenterico-splenic confluence (PMSC), may sometimes be necessary if the tumor is close to the portal venous system. Recently, this extended resection has been widely accepted in high-volume centers for pancreatic resection due to its favorable outcomes compared with non-operative treatment. However, in patients with long-term survival, sinistral portal hypertension (SPH) occurs as a late-onset postoperative complication. These patients present gastrointestinal varices due to congested venous flow from the spleen, which may cause critical variceal bleeding. Since the prognosis of patients with pancreatic cancer has improved, owing to the development of chemotherapy and surgical techniques, SPH is no longer a negligible matter in the field of pancreatic cancer surgery. This review clarifies the pathogenesis and frequency of SPH after PD through PMSC resection and discusses its prediction and prevention.
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