학술논문

Total portal vein replacement with peritoneal interposition graft during Whipple’s procedure for extrahepatic cholangiocarcinoma: a technical report
Document Type
article
Source
World Journal of Surgical Oncology, Vol 21, Iss 1, Pp 1-8 (2023)
Subject
Distal cholangiocarcinoma
Pancreaticoduodenectomy
Graft
Parietal peritoneum
Hepatic surgery
Vascular reconstruction
Surgery
RD1-811
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Language
English
ISSN
1477-7819
Abstract
Abstract Background Aggressive surgical resection in locally advanced hepatopancreatobiliary (HPB) malignancies is frequently advocated as the only potentially curative treatment. In recent years, advances in chemotherapy regimens and surgical techniques have led to improved oncologic outcomes and overall survival, by increasing the rates of radical (R0) resections. Vascular resections are increasingly reported to further increase disease clearance rates. Within this perspective, the issue of vascular reconstruction has raised growing interest, drawing particular attention to vascular substitutes and surgical techniques for reconstruction. Case presentation A case of extrahepatic cholangiocarcinoma with high clinical suspicion of vascular infiltration of the portal trunk at preoperative assessment is reported. An autologous interposition graft, harvested from diaphragmatic peritoneum, was chosen as a vascular substitute leading to successful portal trunk reconstruction and overcoming all possible drawbacks associated with cadaveric and artificial grafts reconstructions. Conclusion This solution was strategic to ensure complete oncologic clearance averting the risk of positive margins (R1) at final pathology.