Peritoneal patch reconstruction following pancreaticoduodenectomy with venous resection for pancreatic head carcinoma
DOI:
https://doi.org/10.5281/zenodo.14963067Keywords:
pancreaticoduodenectomy, venous resection, peritoneal-patch reconstructionAbstract
Background. Most patients diagnosed with pancreatic cancer are at an advanced stage. Surgery is the only treatment that offers a potential cure. For patients with borderline resectable pancreatic cancer, vascular resection has been shown to be feasible and provides survival benefits. This study aims to evaluate the feasibility and safety of using a peritoneal patch during venous resections for pancreatic cancer.
Methods. Reconstruction of the resected portal or superior mesenteric vein may be accomplished using sutures or prosthetic materials. Direct closure is preferable, as prosthetic grafts are associated with a significant risk of thrombotic or infectious complications. Unfortunately, primary closure is not always possible. The parietal peritoneum has recently been introduced as a potential vascular patch for reconstructing the mesenteric-portal axis. This report presents our initial experience utilizing a patch from the falciform hepatic ligament in a ninth patient over five years.
Results. All nine patients underwent pylorus-preserving pancreaticoduodenectomy due to carcinoma of the head of the pancreas. This procedure included subsequent venous resection and reconstruction using a patch from the falciform ligament of the liver. The average clamping time during surgery was 27 minutes, and intraoperative hemotransfusion was necessary in 5 cases (55.6 %). Histological examination confirmed R0 resection in all patients, though verified venous infiltration was present in 8 (88.9 %). Major complications classified as Clavien-Dindo > II, which included bleeding and reoperation, occurred in 2 patients (22.2 %). There was one postoperative mortality (11.1 %) attributed to the development of a Grade "C" pancreatic fistula following hemorrhage.
Conclusions. In selected patients, venous resection and peritoneal patch reconstruction are considered feasible and safe when performed by an experienced team at a high-volume centre. The falciform ligament is a dependable option for venous reconstruction, given its accessibility in the same surgical field. Furthermore, the peritoneum exhibits more excellent resistance to infection than synthetic grafts, and its mesothelial lining protects against thrombosis.
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Copyright (c) 2025 Tsvetan Trichkov, Vassil Mihaylov, Radoslav Kostadinov, Nikola Vladov (Author)
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