Nicolas Cabrit1, Camélia Labiad1, Béatrice Aussilhou1, Riccardo Sartoris2, Alain Sauvanet1, Safi Dokmak3. 1. Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France. 2. Department of Radiology, AP-HP, Hôpital Beaujon, Clichy, France. 3. Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France. safi.dokmak@aphp.fr.
Abstract
BACKGROUND: Laparoscopic resection of the inferior vena cava (IVC) during laparoscopic pancreatoduodenectomy (LPD) has never been described. A 32-year-old male with large solid pseudopapillary neoplasm underwent LPD with resection of the IVC and reconstruction by a peritoneal patch (PP). METHODS: In this indication, the dissection is achieved by resection of the IVC. Kocher maneuver is difficult owing to the caval invasion, and section of the retroportal lamina tissue, before Kocher maneuver, is needed to control the left side of the IVC. Extended lymphadenectomy is not needed because the risk of lymph node invasion is low, and venous resection may be required for severe tumor adhesions without necessary histological invasion, to avoid tumor rupture at high risk of recurrence.1,2 The IVC was clamped by a laparoscopic vascular clamp and reconstructed (5-6 cm) with a PP. RESULTS: The operative duration was 430 min, including IVC clamping for 27 min. The outcome was marked by biliary fistula and 24 days of hospital stay. Histology showed 6 cm tumor without histological invasion of the IVC wall. After 15 months of follow-up, there was no recurrence and no stenosis of the IVC. In our experience, reconstruction of the IVC with a PP is a safe procedure, with no PP-related complications and high patency rate (> 90%).3 CONCLUSION: Laparoscopic resection of the IVC is feasible in highly selected centers. The harvesting of the PP is easier than that of other autologous venous grafts, especially when done by the laparoscopic approach.
BACKGROUND: Laparoscopic resection of the inferior vena cava (IVC) during laparoscopic pancreatoduodenectomy (LPD) has never been described. A 32-year-old male with large solid pseudopapillary neoplasm underwent LPD with resection of the IVC and reconstruction by a peritoneal patch (PP). METHODS: In this indication, the dissection is achieved by resection of the IVC. Kocher maneuver is difficult owing to the caval invasion, and section of the retroportal lamina tissue, before Kocher maneuver, is needed to control the left side of the IVC. Extended lymphadenectomy is not needed because the risk of lymph node invasion is low, and venous resection may be required for severe tumor adhesions without necessary histological invasion, to avoid tumor rupture at high risk of recurrence.1,2 The IVC was clamped by a laparoscopic vascular clamp and reconstructed (5-6 cm) with a PP. RESULTS: The operative duration was 430 min, including IVC clamping for 27 min. The outcome was marked by biliary fistula and 24 days of hospital stay. Histology showed 6 cm tumor without histological invasion of the IVC wall. After 15 months of follow-up, there was no recurrence and no stenosis of the IVC. In our experience, reconstruction of the IVC with a PP is a safe procedure, with no PP-related complications and high patency rate (> 90%).3 CONCLUSION: Laparoscopic resection of the IVC is feasible in highly selected centers. The harvesting of the PP is easier than that of other autologous venous grafts, especially when done by the laparoscopic approach.
Authors: Giovanni Marchegiani; Stefano Andrianello; Marta Massignani; Giuseppe Malleo; Laura Maggino; Salvatore Paiella; Cristina R Ferrone; Claudio Luchini; Aldo Scarpa; Paola Capelli; Mari Mino-Kenudson; Keith D Lillemoe; Claudio Bassi; Carlos Fernàndez-Del Castillo; Roberto Salvia Journal: J Surg Oncol Date: 2016-07-29 Impact factor: 3.454