Cancer of the Pancreas –
Removal and Replacement of the Portal and the Superior Mesenteric Vein

A 60 year-old man was developed cancer of the head and neck of the pancreas. Both CT-scan and Endoscopic Ultrasonography (EUS) demonstrated extensive involvement of the major veins behind the pancreas: the tumor involved 4cm of the superior mesenteric-portal vein junction and 3cm of the splenic vein. This tumor was thought to be unresectable in several hospitals. During the operation we extensively mobilized the pancreas, dissected it free from the superior mesenteric artery, so eventually it remained attached only to the involved veins. At this point, the whole pancreas was removed along with the portal, the superior mesenteric and the splenic veins. The continuity of the vein was re-established using a PTFE graft.

Portal vein involvement is the most common reason that pancreatic tumors (without metastases) are thought to be unresectable. However, when appropriate expertise and experience are present, this may not be true. This technique of “en-block” resection of the portal vein with the pancreas is implemented in a very limited number of centers all over the world and requires very advanced experience in pancreatic surgery. We have utilized this technique in several patients, helping them to get rid of tumors that are conventionally considered impossible-to-remove.

Parts of the portal and superior mesenteric vein infiltrated by pancreatic cancer

Parts of the portal and superior mesenteric vein infiltrated by pancreatic cancer

Cancer of the head and body of pancreas, which is infiltrating the portal, superior mesenteric and splenic vein, in great extent. Conventionally, it is considered «unresectable».

Parts of the portal and superior mesenteric vein that are
to be resected

Parts of the portal and superior mesenteric vein that are to be resected

The picture shows the infiltrated portion of the portal and superior mesenteric veins, and all their extent that has to be resected, so a radical and curative operation can be achieved.

Graft for reconstruction of the long resected portion of the portal and superior mesenteric veins

Graft for replacement of the resected portal and superior mesenteric veins

After resection of a great length of the infiltrated vein, the missing vein is replaced by a graft.

The resected tumor of the pancreas, along with the infiltrated portal vein

The resected tumor of the pancreas, along with the infiltrated portal vein

The resected tumor of the pancreas, along with the infiltrated portal and superior mesenteric vein.