Redirecting venous flow from the superior mesenteric vein to the inferior mesenteric vein in resections for locally advanced pancreatic cancer.

Objective: To evaluate the outcome of ligation of the superior mesenteric vein (SMV) and redirection the venous flow through the inferior mesenteric vein (IMV) in selected patients with pancreatic cancer.

Background: Radical surgery is the only potentially curable treatment of pancreatic cancer. Tumor-invasion of the SMV and its attributes will in some cases make it impossible to reconstruct the venous flow.

Methods: Consecutive patients with pancreatic cancer operated between January 2019 and December 2022 were included. Selected patients eligible for venous flow reversal after systemic chemotherapy were offered surgical exploration.

Results: Eleven patients were offered surgery and nine of these went through radical resection with redirection of the venous flow through the IMV. True histological R0 resection was achieved in 6 (67%) patients. No 30- nor 90-days mortality was recorded. Median overall survival was 23.2 ± 11.5 months.

Conclusion: Redirecting venous flow through the IMV while sacrificing the SMV during pancreatic resection is a safe procedure and may provide the opportunity for curative resection in otherwise unresectable patients.