Transient intraoperative Ileo-Caval shunt in the resection of locally advanced pancreatic head adenocarcinoma: breaking through a glass ceiling?

The resection of locally advanced adenocarcinoma of the pancreatic head with occlusion of the superior mesenteric vein and involvement of the splenomesenteric portal confluence (EMP) sometimes requires prolonged venous clamping with risk of intestinal ischemia. The use of intraoperative venous shunts has been published by reference groups to allow successful resection. In our centre we performed a total pancreatoduodenectomy for locally advanced pancreatic head adenocarcinoma with superior mesenteric vein occlusion (SMV) and splenomesenteric portal confluence. The use of a temporary ileo-caval shunt via a venous graft allowed resection of the tumour without repercussion on the bowel. The surgery ended with closure of the shunt, anastomosis of the graft to the portal vein and digestive reconstruction. The patient presented good tolerance to surgery and was discharged on the 7th postoperative day. The pathology report described pancreatic adenocarcinoma ypT1N0(R0) regression grade GRT2/IIa, with 0/30 affected adenopathies.