Work

Technical Aspects of Patch Reconstruction during Open and Robotic Pancreatoduodenectomy with Venous Resection: Preserving Venous Axis and Collaterals without Sacrificing Radicality

Year: 2025

Type: article

Abstract: BACKGROUND: Different techniques for venous resection and reconstruction during pancreatoduodenectomy are available, each with different advantages and drawbacks. PATIENTS AND METHODS: In this multimedia article, a detailed description of the surgical technique of venous resection with peritoneal (falciform) patch reconstruction is provided, including examples of extended (> 5 cm) or low (jejunal veins confluence) venous infiltrations, during both open and robotic pancreatoduodenectomy. RESULTS: Reconstruction with patch is a versatile technique, typically fit for lateral but cranio-caudally prolonged tumor involvements, which unlike segmental resection allows preservation of venous collaterals, where a simple tangential resection would jeopardize oncologic radicality or increase the risk of stenosis. Moreover, maintaining the original venous axis and direction, it avoids the risk of torsion or kinking potentially associated with segmental resection with or without interposition graft. CONCLUSIONS: The patch reconstruction combines the advantages of both tangential and segmental resection. It can be used for low or extended infiltrations, during open or robotic surgery, preserving venous collaterals without sacrificing radicality, and using prophylactic anticoagulation only.

Source: Annals of Surgical Oncology

DOI: 10.1245/s10434-025-18148-1

Authors: Umberto Cillo, Giampaolo Perri, Enrico Gringeri, Domenico Bassi, Giovanni Marchegiani

Institution: University of Padua

Language: English

Topic: Pancreatic and Hepatic Oncology Research

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,590