Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Do jejunal veins matter during pancreaticoduodenectomy?

  • Mee Joo Kang (Center for Liver and Pancreatobiliary Cancer, National Cancer Center) ;
  • Sung-Sik Han (Center for Liver and Pancreatobiliary Cancer, National Cancer Center) ;
  • Sang-Jae Park (Center for Liver and Pancreatobiliary Cancer, National Cancer Center) ;
  • Hyeong Min Park (Center for Liver and Pancreatobiliary Cancer, National Cancer Center) ;
  • Sun-Whe Kim (Center for Liver and Pancreatobiliary Cancer, National Cancer Center)
  • Received : 2022.02.21
  • Accepted : 2022.03.28
  • Published : 2022.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

When planning pancreaticoduodenectomy for pancreatic head cancer, the prevalence of anatomical variation of the proximal jejunal vein (PJV), the associated short-term surgical outcomes, and the level of PJV convergence to the superior mesenteric vein must be carefully analyzed from both technical and oncological points of view. The prevalence of the first jejunal trunk (FJT) and PJV located ventral to the superior mesenteric artery is 58%-88% and 13%-37%, respectively. Patients with the FJT had a larger amount of intraoperative bleeding and a higher proportion of patients requiring transfusions compared to those without a common trunk. The risk of transfusion was higher in patients with ventral PJV compared to those with dorsal PJV. Although less frequent, sacrificing the FJT can result in fatal venous congestion of the jejunum. Therefore, a well-planned approach for pancreaticoduodenectomy, based on preoperative evaluation of anatomical variation in the PJV, may help reduce intraoperative bleeding and postoperative morbidity. Additionally, the importance of invasion into the PJVs should be revisited in terms of resectability and oncological clearance.

Keywords

References

  1. Kawai M, Tani M, Ina S, Hirono S, Nishioka R, Miyazawa M, et al. CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy. World J Surg 2008;32:82-87.
  2. Kobayashi Y, Sakamoto Y, Arita J, Akamatsu N, Kaneko J, Hasegawa K, et al. Vascular anatomy of the jejunal mesentery and complications associated with division of the first jejunal venous trunk during pancreaticoduodenectomy. J Surg Oncol 2018;117:1297-1304.
  3. Ishikawa Y, Ban D, Matsumura S, Mitsunori Y, Ochiai T, Kudo A, et al. Surgical pitfalls of jejunal vein anatomy in pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 2017;24:394-400.
  4. Katz MH, Fleming JB, Pisters PW, Lee JE, Evans DB. Anatomy of the superior mesenteric vein with special reference to the surgical management of first-order branch involvement at pancreaticoduodenectomy. Ann Surg 2008;248:1098-1102.
  5. Nakamura M, Nakashima H, Tsutsumi K, Matsumoto H, Muta Y, Ueno D, et al. First jejunal vein oriented mesenteric excision for pancreatoduodenectomy. J Gastroenterol 2013;48:989-995.
  6. Shukla PJ, Barreto SG, Kulkarni A, Nagarajan G, Fingerhut A. Vascular anomalies encountered during pancreatoduodenectomy: do they influence outcomes? Ann Surg Oncol 2010;17:186-193.
  7. Japan Pancreas Society. Classification of pancreatic carcinoma. 4th English ed. Tokyo: Kanehara & Co., 2017.
  8. Hamabe A, Park S, Morita S, Tanida T, Tomimaru Y, Imamura H, et al. Analysis of the vascular interrelationships among the first jejunal vein, the superior mesenteric artery, and the middle colic artery. Ann Surg Oncol 2018;25:1661-1667.
  9. Nishimura S, Takahashi H, Akita H, Asukai K, Hasegawa S, Yamada D, et al. The anatomical pattern of the proximal jejunal vein as a prognostic factor in patients with pancreatic head cancer treated with preoperative chemoradiation therapy. Anticancer Res 2019;39:5821-5830.
  10. Sakaguchi T, Suzuki S, Morita Y, Oishi K, Suzuki A, Fukumoto K, et al. Analysis of anatomic variants of mesenteric veins by 3-dimensional portography using multidetector-row computed tomography. Am J Surg 2010;200:15-22.
  11. Kim HJ, Ko YT, Lim JW, Lee DH. Radiologic anatomy of the superior mesenteric vein and branching patterns of the first jejunal trunk: evaluation using multi-detector row CT venography. Surg Radiol Anat 2007;29:67-75.
  12. Hosokawa Y, Nagakawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y, et al. Surgical outcomes of pancreaticoduodenectomy for pancreatic cancer with proximal dorsal jejunal vein involvement. J Gastrointest Surg 2018;22:1179-1185.
  13. Graf O, Boland GW, Kaufman JA, Warshaw AL, Fernandez del Castillo C, Mueller PR. Anatomic variants of mesenteric veins: depiction with helical CT venography. AJR Am J Roentgenol 1997;168:1209-1213.
  14. Horton KM, Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions. Radiographics 2002;22:161-172.
  15. Negoi I, Beuran M, Hostiuc S, Negoi RI, Inoue Y. Surgical anatomy of the superior mesenteric vessels related to pancreaticoduodenectomy: a systematic review and meta-analysis. J Gastrointest Surg 2018;22:802-817.
  16. Inoue Y, Saiura A, Yoshioka R, Ono Y, Takahashi M, Arita J, et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 2015;262:1092-1101.
  17. Takemura N, Miki K, Kosuge T. New portal-superior mesenteric vein reconstructions using first jejunal vein flap in pancreaticoduodenectomy. World J Surg 2016;40:1462-1466.
  18. Papavasiliou P, Arrangoiz R, Zhu F, Chun YS, Edwards K, Hoffman JP. The anatomic course of the first jejunal branch of the superior mesenteric vein in relation to the superior mesenteric artery. Int J Surg Oncol 2012;2012:538769.
  19. Hutan M, Bartko C, Slysko R, Sekac J, Prochotsky A, Majesky I, et al. Superior mesenteric vein thrombosis - unusual management of unusual complication of Whipple procedure. Int J Surg Case Rep 2014;5:765-768.
  20. Katz MH, Lee JE, Pisters PW, Skoracki R, Tamm E, Fleming JB. Retroperitoneal dissection in patients with borderline resectable pancreatic cancer: operative principles and techniques. J Am Coll Surg 2012;215:e11-e18.
  21. Kayashima H, Maeda T, Harada N, Masuda T, Ohmine T, Yamaguchi S, et al. One-step surgery for acute ischemia of the jejunal loop after pancreatoduodenectomy: report of a case. Surg Case Rep 2016;2:24.
  22. Zyromski NJ, Howard TJ. Acute superior mesenteric-portal vein thrombosis after pancreaticoduodenectomy: treatment by operative thrombectomy. Surgery 2008;143:566-567.
  23. Kim JR, Kim H, Kwon W, Jang JY, Kim SW. Pattern of local recurrence after curative resection in pancreatic ductal adenocarcinoma according to the initial location of the tumor. J Hepatobiliary Pancreat Sci 2021;28:105-114.
  24. National Comprehensive Cancer Network. Pancreatic adenocarcinoma (version 1.2020) [Internet]. Plymouth Meeting: National Comprehensive Cancer Network 2020 [cited 2020 Mar 19]. Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455.
  25. National Comprehensive Cancer Network. Pancreatic adenocarcinoma (version 2.2015) [Internet]. Plymouth Meeting: National Comprehensive Cancer Network 2015 [cited 2015 Dec 1]. Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455.