Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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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
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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.

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References

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