Temporary Mesocaval Shunt: A Surgical Strategy to Facilitate Pancreatic Cancer Resection With Complex Vascular Involvement.

Abstract

Background: Extensive vascular involvement remains a major challenge in the surgical management of borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Temporary mesocaval shunting (tMCS) may facilitate resection in cases of mesenteric venous occlusion or collateralisation and improve exposure of the superior mesenteric artery; however, its use in pancreatic surgery is rarely reported.

Methods: We performed a retrospective case series of patients with borderline or locally advanced PDAC who underwent curative-intent resection with intra-operative tMCS between 2017 and 2022. Demographics, perioperative outcomes, post-operative complications and survival were analysed using the Kaplan-Meier method.

Results: Six patients underwent pancreatectomy with tMCS (three pancreaticoduodenectomies, three total pancreatectomies). Median age was 58.5 years. All shunts used cryopreserved cadaveric iliac vein grafts. Median length of stay was 13 days. Two patients (33%) developed Clavien-Dindo grade ≥III complications, including one post-operative death. R0 resection was achieved in two patients (33%). Median overall survival was 24.8 months (33.2 months excluding post-operative mortality), and median disease-free survival was 8 months.

Conclusion: Selective tMCS may enable resection in PDAC with extensive vascular involvement. This complex approach should be reserved for carefully selected patients at high-volume centres with vascular expertise.