The Whipple Procedure
With Vein Resection
Borderline Resectable Pancreatic Cancer—the adjunct of vein resection and reconstruction during the Whipple procedure.
Pancreatic neoplasms involving the superior mesenteric vein, portal vein, or smv-pv confluence are typically considered unresectable by many pancreatic surgeons. Recent data, however, has demonstrated the feasibility of performing pancreatic resections in combination with portal or superior mesenteric vein resection with extreme safety. Studies have also demonstrated similar survival curves for patients who have undergone this complex resection. We have demonstrated similar results in our personal series of 36 patients undergoing this novel approach over the past three years.
Vein resections can be classified as segmental or tangential. Tangential repairs are repaired by a lateral suture line, requiring less surgical manipulation. Segmental repairs, however, are more complex, requiring a primary end-to-end anastomosis or an interposition venous conduit. Commonly used venous conduits include the superficial femoral vein and internal jugular vein. Our preference has been to use the superficial femoral vein because of the ease of procuring it during abdominal surgery.
Neo-adjuvant radiation is utilized prior to vein resection in circumstances where a margin-negative resection is not deemed possible. Adjuvant radiation follows resection in patients who are treated with surgery upfront.
We are proud to offer portal and superior mesenteric vein resections to patients who qualify for this approach. If you have been deemed inoperable because of tumor adherence to the portal venous system, we would gladly re-evaluate your case for this adjunctive method.
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