Cancer of the Pancreas – Removal and Replacement of the Portal Vein

A 62 year-old man was diagnosed to have cancer of the head of the pancreas, which extended towards and involved the portal vein, as demonstrated in CT-scan and MRI. Because of this finding, his tumor was considered unresectable in several hospitals. Actually, it is very common worldwide when a pancreatic tumor involves the portal vein and/or the superior mesenteric vein to be considered unresectable. Portal vein involvement is the most common reason that pancreatic tumors (without metastases) are thought to be unresectable. However, when appropriate expertise and experience are present, this may not be true.

In this particular patient, the head of the pancreas was removed (Whipple’s operation) along with the segment of the portal vein involved by the tumor. The missing segment was then replaced by a vein “graft” using some other vein of the same patient. So all the tumor was removed and the patient was rendered free of disease after this major operation. This technique of “en-block” resection of the portal vein with the pancreas is implemented in a very limited number of centers all over the world and requires very advanced experience in pancreatic surgery. We have utilized this technique in several patients, helping them to get rid of tumors that are conventionally considered impossible-to-remove.