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Background <p>Pancreatectomies with superior mesenteric artery (SMA) resection are technically challenging.<sup><CitationRef CitationID="CR1">1</CitationRef></sup> With the advent of FOLFIRNOX chemotherapy, resection of the SMA is performed in selected patients with locally advanced pancreatic cancer (LAPC),<sup><CitationRef AdditionalCitationIDS="CR3 CR4 CR5 CR6 CR7 CR8 CR9" CitationID="CR2">2</CitationRef>–<CitationRef CitationID="CR10">10</CitationRef></sup> in centers of excellence by highly skilled pancreatic-vascular surgeons treating a large volume of LAPCs.<sup><CitationRef AdditionalCitationIDS="CR5 CR6 CR7 CR8 CR9" CitationID="CR4">4</CitationRef>–<CitationRef CitationID="CR10">10</CitationRef></sup></p> Methods <p>The patient was a 64-year-old female with an LAPC treated with 11 cycles of FOLFIRINOX induction chemotherapy. The SMA, the superior mesenteric vein (SMV), and a replaced right hepatic artery (r-RHA) were encased. A temporary mesenterico-portal shunt (TMPS), using a 25&#xa0;cm Goretex tube between the origin of the SMV and the right side of the portal vein,<sup><CitationRef CitationID="CR11">11</CitationRef></sup> was used. This TMPS (1) lessens portal hypertension in case of SMV obstruction; (2) maintains adequate liver venous perfusion during dissection; (3) gives the mesentery enough mobility to avoid graft for SMA resection; and (4) avoids simultaneous venous and arterial clamping. A mesenteric approach was performed to isolate the SMA.<sup><CitationRef CitationID="CR12">12</CitationRef></sup> Upon heparin bolus, the r-RHA was re-implanted on the gastroduodenal artery stump, the SMA on the aorta, the SMV on the portal vein, and the splenic vein on the left renal vein.</p> Results <p>Postoperative course was uneventful. Pathology showed pT4N0R1 pancreatic adenocarcinomas. Three years later, the patient recurred on the left adrenal gland and was treated by external radiotherapy. Five years later, the patients is alive under chemotherapy.</p> Conclusions <p>Pancreaticoduodenectomy with SMA and SMV using a transitory mesentericoportal shunt (<i>The Strasbourg technique</i>) is a standardized technique used to manage patients with LAPC at our unit.</p>

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Pancreatoduodenectomy with En Bloc Superior Mesenteric Artery and Vein Resection Under Temporary Mesenterico-Portal Venous Shunt: The Strasbourg Technique

  • 期刊论文

  • 发表日期：

    2025年4月1日

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  • Philippe Bachellier,
  • Pierre de Mathelin,
  • Pietro Addeo

摘要

Background

Pancreatectomies with superior mesenteric artery (SMA) resection are technically challenging.1 With the advent of FOLFIRNOX chemotherapy, resection of the SMA is performed in selected patients with locally advanced pancreatic cancer (LAPC),2–10 in centers of excellence by highly skilled pancreatic-vascular surgeons treating a large volume of LAPCs.4–10

Methods

The patient was a 64-year-old female with an LAPC treated with 11 cycles of FOLFIRINOX induction chemotherapy. The SMA, the superior mesenteric vein (SMV), and a replaced right hepatic artery (r-RHA) were encased. A temporary mesenterico-portal shunt (TMPS), using a 25 cm Goretex tube between the origin of the SMV and the right side of the portal vein,11 was used. This TMPS (1) lessens portal hypertension in case of SMV obstruction; (2) maintains adequate liver venous perfusion during dissection; (3) gives the mesentery enough mobility to avoid graft for SMA resection; and (4) avoids simultaneous venous and arterial clamping. A mesenteric approach was performed to isolate the SMA.12 Upon heparin bolus, the r-RHA was re-implanted on the gastroduodenal artery stump, the SMA on the aorta, the SMV on the portal vein, and the splenic vein on the left renal vein.

Results

Postoperative course was uneventful. Pathology showed pT4N0R1 pancreatic adenocarcinomas. Three years later, the patient recurred on the left adrenal gland and was treated by external radiotherapy. Five years later, the patients is alive under chemotherapy.

Conclusions

Pancreaticoduodenectomy with SMA and SMV using a transitory mesentericoportal shunt (The Strasbourg technique) is a standardized technique used to manage patients with LAPC at our unit.