Elsevier

Advances in Surgery

Volume 51, Issue 1, September 2017, Pages 41-63
Advances in Surgery

Vascular Resections During the Whipple Procedure

https://doi.org/10.1016/j.yasu.2017.03.004Get rights and content

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Key points

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    Pancreatic cancer is currently the third leading cause of cancer death in the United States.

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    Margin negative surgical resection remains a critical component of cure.

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    Preoperative computed tomography or MRI is essential in determining resectability.

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    An experienced team is critical when performing complex vascular resections and reconstructions in this patient cohort.

Significance: brief literature review

In an effort to update the reader concerning recent important contributions to the literature on this topic, this brief literature review is provided.

Because complete macroscopic tumor resection is one of the most important predictors of long-term survival in PDA, the ISGPS recently defined the extent of pancreatectomy in a consensus article by Hartwig and colleagues [4]. In this article, the standard Whipple procedure is defined as removing

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    Head of the pancreas and the uncinate process

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    Duodenum

Defining resectability

In general, the ability of both MRI and CT to predict the presence or absence of vessel involvement is roughly equivalent. The authors prefer high-quality, multidetector CT scan using oral water and intravenous (IV) contrast, with work station reconstructions. In head to head comparisons, CT scan may be somewhat inferior to MRI in detecting either liver or peritoneal metastases, although the many studies that have looked at this have had mixed results. As surgeons, we have found it easier to

Summary

Contemplating a Whipple resection with a vascular resection is a major undertaking. The operation should be planned carefully, with intense scrutiny of the preoperative imaging and attention to the various visceral arteries and veins. Access to autologous vascular conduits is crucial, hence prepping the neck and groins should be a component of each case. It is in the patient’s best interest to avoid major vascular injuries, hence the steps of the Whipple operation should be performed to allow

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References (22)

  • P.I. Pessaux et al.

    Pancreaticoduodenectomy: superior mesenteric artery first approach

    J Gastrointest Surg

    (2006)

    • Cited by (0)

    The authors have nothing to disclose.

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