Massimiliano Tuveri1, Eleonora Milani2, Giovanni Marchegiani3, Luca Landoni3, Evelin Torresani4, Paola Capelli4, Aldo Scarpa4,5, Roberto Salvia3, Christian Vergara6, Claudio Bassi3. 1. General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro n. 10, 37134, Verona, Italy. massimiliano.tuveri@aovr.veneto.it. 2. MOX, Department of Mathematics, Polytechnic University of Milano, Milano, Italy. 3. General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro n. 10, 37134, Verona, Italy. 4. Section of Pathology, Department of Diagnostics and Public Health, University of Verona Hospital Trust, Verona, Italy. 5. ARC-Net Research Center, University of Verona Hospital Trust, Verona, Italy. 6. LABS, Department of Chemical Engineering, Polytechnic University of Milano, Milano, Italy.
Abstract
BACKGROUND: We designed a retrospective computational study to evaluate the effects of hemodynamics on portal confluence remodeling in real models of patients with malignancies of the pancreatic head. METHODS: Patient-specific models were created according to computed tomography data. Fluid dynamics was simulated by using finite-element methods. Computational results were compared to morphological findings. RESULTS: Five patients underwent total pancreatectomy, one had duodenopancreatectomy. Vein resection was performed en-bloc with the specimen. Histopathological findings showed that in patients without a vein stenosis and a normal hemodynamics, the three-layered wall of the vein was preserved. In patients with a stenosis > 70% of vein diameter and modified hemodynamics, the three-layered structure of the resected vein was replaced by a dense inflammatory infiltrate in absence of tumor infiltration. CONCLUSIONS: The portal confluence involved by malignancies of the pancreatic head undergoes a remodeling that is not mainly due to a wall infiltration by the tumor but instead to a persistent pathological hemodynamics that disrupts the balance between eutrophic remodeling and degradative process of the vein wall that can lead to the complete upheaval of the three-layered vein wall. This finding can have useful surgical application in planning resection of the vein involved by tumor growth.
BACKGROUND: We designed a retrospective computational study to evaluate the effects of hemodynamics on portal confluence remodeling in real models of patients with malignancies of the pancreatic head. METHODS: Patient-specific models were created according to computed tomography data. Fluid dynamics was simulated by using finite-element methods. Computational results were compared to morphological findings. RESULTS: Five patients underwent total pancreatectomy, one had duodenopancreatectomy. Vein resection was performed en-bloc with the specimen. Histopathological findings showed that in patients without a vein stenosis and a normal hemodynamics, the three-layered wall of the vein was preserved. In patients with a stenosis > 70% of vein diameter and modified hemodynamics, the three-layered structure of the resected vein was replaced by a dense inflammatory infiltrate in absence of tumor infiltration. CONCLUSIONS: The portal confluence involved by malignancies of the pancreatic head undergoes a remodeling that is not mainly due to a wall infiltration by the tumor but instead to a persistent pathological hemodynamics that disrupts the balance between eutrophic remodeling and degradative process of the vein wall that can lead to the complete upheaval of the three-layered vein wall. This finding can have useful surgical application in planning resection of the vein involved by tumor growth.
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