STEP 12SMV reconstruction

When tumor involvement is limited to the SMV, we preserve the splenic vein-PV junction. Splenic vein preservation is possible only when tumor invasion of the SMV or PV does not involve the splenic vein confluence. Preservation of the splenic vein-SMV-PV confluence significantly limits the mobility of the PV and prevents primary anastomosis of the SMV (after segmental SMV resection) unless segmental resection is limited to less than 2 cm (A-1 ). Therefore, in most patients who undergo SMV resection with splenic vein preservation, an interposition graft using the internal jugular vein is necessary. Preservation of the splenic vein adds significant complexity to venous resection because it prevents direct access to the most proximal 3-4cm of the SMA (medial to the SMV). Venous resection and reconstruction can be performed either before the specimen has been separated from the right lateral wall of the SMA or after complete mesenteric dissection by separating the specimen first from the SMA (A-2). Both techniques require significant experience with pancreatoduodenectomy.

Smv Confluence

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