REGIONAL PANCREATECTOMY WITH PORTAL/SUPERIOR MESENTERIC VEIN RESECTION AND RECONSTRUCTION IN TREATMENT OF PANCREATIC ADENOCARCINOMA: A PRELIMINARY REPORT

Background: Pancreatic adenocarcinoma has poor prognosis and low resectability rates. Resection is the only potential 
curative treatment. Portal vein involvement can be detected either intraoperatively or during preoperative staging. Portal 
vein resection and reconstruction can be performed to increase resectability rate. 
Aim of the study: Is to evaluate the results of early experience in regional pancreatectomy for patients with portal vein 
involvement by carcinoma head of pancreas. 
Methodology: The study included nine patients with carcinoma head of pancreas and involvement of portal /superior 
mesenteric vein confluence. Regional pancreatectomy has been done with portal/ superior mesenteric vein resection and 
reconstruction. Saphenous vein was used in 2 cases and superficial femoral vein in 7 cases. The effect of different factors as demographic data, operative factors, tumor factors and types of grafts on morbidity and mortality were studied 
Results: Three cases of mortality mainly due to liver cell failure and 6 cases survived 6 to 12 months during the first year of follow up. Graft thrombosis occurred in two cases, biliary leakage in one case and severe intestinal edema in 2 cases due to portal vein clamping. No single factor has its impact on survival. 
Conclusion: Involvement of the portal/ superior mesenteric vein is not a contraindication to resection. Regional 
pancreatectomy offers free safety margin of resection and can be facilitated by consideration of some technical steps during the procedure. The Superficial femoral vein can be used as a graft for reconstruction with minimal limb morbidity.