Sinistral Portal Hypertension after Pancreaticoduodenectomy with Splenic Vein Resection: Pathogenesis and Its Prevention

被引:16
作者
Ono, Yoshihiro [1 ]
Inoue, Yosuke [1 ]
Kato, Tomotaka [1 ]
Matsueda, Kiyoshi [2 ]
Oba, Atsushi [1 ]
Sato, Takafumi [1 ]
Ito, Hiromichi [1 ]
Saiura, Akio [3 ]
Takahashi, Yu [1 ]
机构
[1] Japanese Fdn Canc Res, Canc Inst Hosp, Div Hepatobiliary & Pancreat Surg, Tokyo 1358550, Japan
[2] Japanese Fdn Canc Res, Canc Inst Hosp, Dept Diagnost Imaging, Tokyo 1358550, Japan
[3] Juntendo Univ, Sch Med, Dept Hepatobiliary Pancreat Surg, Tokyo 1130033, Japan
关键词
sinistral portal hypertension; pancreatic cancer; pancreaticoduodenectomy; splenic vein ligation/resection; gastrointestinal varices; gastrointestinal bleeding; VENOUS COLLATERAL DEVELOPMENT; CANCER; VARICES; ARTERY; RECONSTRUCTION; ANASTOMOSIS; OCCLUSION; WHIPPLE; CONFLUENCE; INVASION;
D O I
10.3390/cancers13215334
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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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页数:13
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