Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer
Pancreatic cancer involving the porto-mesenteric junction (PMJ) represents a challenge to pancreatic surgeons. Restoring mesenteric venous drainage is an essential component of vascular reconstruction after tumour resection. In contrast, management of the splenic venous drainage can involve the liga...
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MDPI AG
2025-05-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/32/6/316 |
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| author | Moath Alarabiyat Nikolaos Chatzizacharias |
| author_facet | Moath Alarabiyat Nikolaos Chatzizacharias |
| author_sort | Moath Alarabiyat |
| collection | DOAJ |
| description | Pancreatic cancer involving the porto-mesenteric junction (PMJ) represents a challenge to pancreatic surgeons. Restoring mesenteric venous drainage is an essential component of vascular reconstruction after tumour resection. In contrast, management of the splenic venous drainage can involve the ligation or reconstruction of the splenic vein (SV). Evidence suggests that splenic vein ligation (SVL) is commonly associated with sinistral portal hypertension (SPH), especially if multiple venous tributaries were divided to facilitate resection. Although the association between SVL and SPH is well documented, the risk of symptomatic SPH is not widely reported, presumably due to the low incidence and poor survival of pancreatic cancer patients. Splenic vein reconstruction (SVR) has been proposed to decrease the risk of SPH but is fraught with technical complexity and increased morbidity. Moreover, SVR does not guarantee the prevention of SPH, as patency rates vary and associated hemodynamic changes are unpredictable. Patient selection and the surgical expertise available can guide SV intraoperative management, taking into consideration the risks and benefits associated with each approach. A comprehensive review of the current literature highlighting the incidence and clinical impact of SPH after the resection of pancreatic cancer involving the PMJ is presented. |
| format | Article |
| id | doaj-art-88aaebab6ea445aeaf2ef8ca4fba9cc1 |
| institution | Matheson Library |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Current Oncology |
| spelling | doaj-art-88aaebab6ea445aeaf2ef8ca4fba9cc12025-06-25T13:41:29ZengMDPI AGCurrent Oncology1198-00521718-77292025-05-0132631610.3390/curroncol32060316Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic CancerMoath Alarabiyat0Nikolaos Chatzizacharias1Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UKDepartment of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UKPancreatic cancer involving the porto-mesenteric junction (PMJ) represents a challenge to pancreatic surgeons. Restoring mesenteric venous drainage is an essential component of vascular reconstruction after tumour resection. In contrast, management of the splenic venous drainage can involve the ligation or reconstruction of the splenic vein (SV). Evidence suggests that splenic vein ligation (SVL) is commonly associated with sinistral portal hypertension (SPH), especially if multiple venous tributaries were divided to facilitate resection. Although the association between SVL and SPH is well documented, the risk of symptomatic SPH is not widely reported, presumably due to the low incidence and poor survival of pancreatic cancer patients. Splenic vein reconstruction (SVR) has been proposed to decrease the risk of SPH but is fraught with technical complexity and increased morbidity. Moreover, SVR does not guarantee the prevention of SPH, as patency rates vary and associated hemodynamic changes are unpredictable. Patient selection and the surgical expertise available can guide SV intraoperative management, taking into consideration the risks and benefits associated with each approach. A comprehensive review of the current literature highlighting the incidence and clinical impact of SPH after the resection of pancreatic cancer involving the PMJ is presented.https://www.mdpi.com/1718-7729/32/6/316pancreatic cancersplenic vein ligationsplenic vein reconstructionsinistral portal hypertensionvenous resectionpancreatic resection |
| spellingShingle | Moath Alarabiyat Nikolaos Chatzizacharias Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer Current Oncology pancreatic cancer splenic vein ligation splenic vein reconstruction sinistral portal hypertension venous resection pancreatic resection |
| title | Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer |
| title_full | Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer |
| title_fullStr | Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer |
| title_full_unstemmed | Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer |
| title_short | Necessity and Reconstruction Methods of Splenic Vein After Resection of the Portomesenteric Junction During Resections for Pancreatic Cancer |
| title_sort | necessity and reconstruction methods of splenic vein after resection of the portomesenteric junction during resections for pancreatic cancer |
| topic | pancreatic cancer splenic vein ligation splenic vein reconstruction sinistral portal hypertension venous resection pancreatic resection |
| url | https://www.mdpi.com/1718-7729/32/6/316 |
| work_keys_str_mv | AT moathalarabiyat necessityandreconstructionmethodsofsplenicveinafterresectionoftheportomesentericjunctionduringresectionsforpancreaticcancer AT nikolaoschatzizacharias necessityandreconstructionmethodsofsplenicveinafterresectionoftheportomesentericjunctionduringresectionsforpancreaticcancer |