Detailed Abstract
[BP Video Exhibition - Biliary & Pancreas (Biliary Disease/Surgery)]
[BP VE 4] Superior Mesenteric-portal Vein Tangential Excision & Transverse Closure during Open Pancreatoduodenectomy for Pancreas Head Cancer
Yang Won NAH 1, Ye Won JEON 2, Jung Ik PARK 1
1 Department of Surgery, Ulsan University Hospital, REPUBLIC OF KOREA, 2 Department of Pancreatic Surgery, Asan Medical Center, REPUBLIC OF KOREA
Background : In this video, level 3 SMA dissection for PDAC, total mesopancreatodeodenum excision by left side approach and tangential excision and transverse closure technique of superior mesenteric-portal vein will be presented.
Methods : The case is a 72 years old female presenting with dyspnea, jaundice and hypotension, possibly due to cholangitis. BMI was 29.76. On CT and MR, 3.1cm sized hypoenhancing mass was identified in the pancreatic head, suggesting pancreas head cancer. Serum bilirubin level was 8.7 mg/dl and PTBD was inserted. Bilirubin and CRP was normalized before surgery. CA 19-9 level also fell to 147 AU/ml from 326. The tumor was abutting the SMV by 180 degrees. SMV was reconstructable. The tumor was abutting the SMA focally, necessitating total meso-pancreato-duodenum excision. Inferior PD artery and J1 artery was coming as a common trunk from the 5 o’clock direction of the SMA. Small proximal dorsal jejunal vein was running behind the SMA and will be cut during surgery. There was no evidence of distant metastasis on PET CT scan.
Results : The operation took 7 hours and 45 minutes. Blood loss was minimal. There was no POPF. Pathologically R0 resection was accomplished. SMV was invaded by the cancer. On postoperative CT scan, superior mesenteric-portal vein and splenic vein were all patent.
Conclusions : In conclusions, total mesopancreatodeodenum excision can be done by left side approach under clear view and facilitates level 3 dissection of the SMA. And tangential excision and transverse closure technique is another option for cancer invasion of superior mesenteric-portal vein.
Methods : The case is a 72 years old female presenting with dyspnea, jaundice and hypotension, possibly due to cholangitis. BMI was 29.76. On CT and MR, 3.1cm sized hypoenhancing mass was identified in the pancreatic head, suggesting pancreas head cancer. Serum bilirubin level was 8.7 mg/dl and PTBD was inserted. Bilirubin and CRP was normalized before surgery. CA 19-9 level also fell to 147 AU/ml from 326. The tumor was abutting the SMV by 180 degrees. SMV was reconstructable. The tumor was abutting the SMA focally, necessitating total meso-pancreato-duodenum excision. Inferior PD artery and J1 artery was coming as a common trunk from the 5 o’clock direction of the SMA. Small proximal dorsal jejunal vein was running behind the SMA and will be cut during surgery. There was no evidence of distant metastasis on PET CT scan.
Results : The operation took 7 hours and 45 minutes. Blood loss was minimal. There was no POPF. Pathologically R0 resection was accomplished. SMV was invaded by the cancer. On postoperative CT scan, superior mesenteric-portal vein and splenic vein were all patent.
Conclusions : In conclusions, total mesopancreatodeodenum excision can be done by left side approach under clear view and facilitates level 3 dissection of the SMA. And tangential excision and transverse closure technique is another option for cancer invasion of superior mesenteric-portal vein.
SESSION
BP Video Exhibition
Video Exhibition 3/21/2024 12:00 AM - 12:00 AM