Splenic vein turndown for vascular reconstruction following pancreatic cancer resection in patients with high risk profile

Abstract

Introduction: Vascular reconstruction is utilized following resections for pancreatic cancers with borderline resectability. This is defined by venous or partial superior mesenteric artery (SMA) involvement, where vessels are resected en bloc to achieve an R0 resection. There are many vascular reconstruction techniques post en bloc R0 resection, each with its own complication profile. The splenic turndown technique separates the vascular anastomosis from the pancreatic anastomosis, reducing the risk of vascular disruption should a pancreatic leak occur. Case Report: This is the first report in literature of the splenic vein turndown technique being utilized for vascular reconstruction post- pancreatic resection for borderline resectable pancreatic cancer. To date, splenic vein turndown repair has only been described in a trauma setting. In this case, splenic vein turndown was preferred as the patient was on long-term corticosteroids with a high risk of anastomotic leak. Conclusion: This case report showing that splenic vein turndown technique is a feasible option for vascular reconstruction post-pancreatic resection. The main disadvantage of this technique is high risk of segmental portal hypertension if the spleen is not removed concomitantly. For this reason, its utility should be restricted to patients at high risk of pancreatic leak.