Selection and Prognosis of Different Venous Reconstruction Methods in Laparoscopic Pancreatectomy

Abstract

Pancreatic cancer is a highly malignant tumor of the digestive system and has an extremely poor prognosis. Due to its insidious onset and rapid progression, major surrounding vessels are frequently invaded at the time of diagnosis. Consequently, resection and reconstruction of the portal vein and/or superior mesenteric vein are often required during pancreatectomy. Various methods of venous resection and reconstruction have been developed, each with its own advantages, limitations, and specific applicability. Compared with open surgery, laparoscopic pancreatectomy requires higher technical proficiency and more precise intraoperative decision-making. To promote the advancement of venous reconstruction techniques in laparoscopic pancreatectomy, in this article, we summarize and evaluate our team’s practical experience and relevant literature, focusing on graft selection, technical difficulty, operative risk, and short- and long-term patency. Special emphasis was placed on the applicability of different approaches and materials. In addition, regarding postoperative reconstruction of venous patency, we introduced the “Cross-sectional Area Algorithm”, a method simulating the evaluation mode of coronary artery patency, to accurately quantify postoperative venous patency. The evaluation method was first proposed by the team but has not yet been externally validated. By reviewing the current status of venous reconstruction strategies and the prognosis of laparoscopic pancreatic surgery, we aim to inform the development of standardized technical guidelines, enable individualized assessment of venous patency after surgery, and ultimately improve minimally invasive pancreatic surgery and the long-term prognosis of patients.

Keywords: Pancreatectomy, Laparoscopy, Graft occlusion, vascular, Review