Portal Venous Stenting in Locally Advanced Pancreatic Cancer to Decrease Risk of Thrombosis Before Irreversible Electroporation: A Case Report and Review of the Literature.

Abstract

Background: For patients with locally advanced pancreatic cancer, irreversible electroporation (IRE) is a fairly novel treatment tool that has shown promise in improving survival. However, many patients being considered for IRE have tumors adjacent to and/or encasing portal vasculature, increasing risk of postoperative portal vein thrombosis and associated complications. This report describes a successful new approach of portal venous stenting preoperatively to decrease this risk. Case Presentation: A 64-year-old female with locally advanced pancreatic cancer, initially deemed too high risk for IRE therapy because of portal vein-superior mesenteric vein confluence encasement and compression, was offered and underwent venous stenting to decrease the chance of postoperative thrombosis and related complications. Stenting improved portal venous flow, decreased collateralization, and allowed for successful IRE. At 61 days post-IRE, there was no significant tumor growth and the stent remained patent. Conclusion: Preoperative portomesenteric stenting could expand the population eligible for IRE therapy, allowing for this treatment in patients without other options. To the authors' knowledge, this is the first reported case of portal venous stenting for this purpose.