Oncovascular surgery: first two case reports and teamwork perspective

Abstract

BACKGROUND: Surgical resection remains the cornerstone for the curative treatment of malignant tumors, such as pancreatic adenocarcinomas. Pancreaticoduodenectomy with vascular reconstruction is a promising approach for tumors invading the portomesenteric vein, and an aggressive surgical approach can improve survival in the mid- and long terms. Thus, vascular surgeons have an increasing role in these surgeries. Therefore, we describe our recent and initial experience and efforts to grow as a true team to offer a better and more systematic response to these patients. CASE REPORTS: We present two cases of 68 and 69-year-old female patients, both with pancreatic head adenocarcinoma. In the first case, during the pancreaticoduodenectomy, a 4 cm long involvement of the portomesenteric vein in 50% of its circumference was denoted. The choice for reconstruction after tumor resection was a primary repair with a Dacron patch. In the second case, the resection was programmed after neoadjuvant chemotherapy, and a circumferential involvement of the portomesenteric vein in a long extension was observed, requiring an extensive venous reconstruction with an interposition graft (Dacron - 8mm) with splenic vein reimplantation. In both cases, disease-free margins were achieved, and no mortality was registered within 30 days after surgery. CONCLUSIONS: With these two initial cases, we concluded that good results can be achieved. Our center's team is working to preoperatively delineate our strategy for treating these complex patients, choosing optimal vascular reconstructive options tailored to each patient. Recently, a bovine pericardium patch became available in our institution, which is a good alternative to avoid additional operative time and reduce the infection risk associated with synthetic material use.