Abstract
Background/aim
Pancreatic cancer with chronic portal vein (PV) occlusion presents technical challenges because interruption of collateral venous circulation may result in mesenteric venous congestion, bowel edema, and excessive blood loss. Here, we report a case of locally advanced pancreatic cancer with complete PV occlusion that was successfully treated with pancreaticoduodenectomy and PV resection using temporary intraoperative mesocaval bypass.Case report
A 79-year-old man was diagnosed with unresectable, locally advanced pancreatic cancer involving the PV and major peripancreatic arteries. After chemo- and chemoradiotherapy, the tumor showed a favorable biological response without disease progression, and conversion surgery was planned. During laparotomy, complete PV occlusion with extensive collateral venous circulation was confirmed. After curative resection was deemed feasible, a temporary mesocaval bypass was established between the superior mesenteric vein and inferior vena cava using an 8-mm ringed expanded polytetrafluoroethylene graft, allowing continuous mesenteric venous drainage during prolonged dissection and PV resection. Pancreaticoduodenectomy with PV resection was successfully completed, and direct PV-superior mesenteric vein reconstruction was performed after tumor removal. No intraoperative bowel congestion, edema, or ischemia was observed. The patient experienced no major postoperative complications.Conclusion
Temporary intraoperative mesocaval bypass may facilitate safe radical resection in select patients with locally advanced pancreatic cancer complicated by PV occlusion and extensive collateral circulation.