A novel technique for initially unresectable locally advanced pancreatic body cancer: pre-resection portal vein reconstruction.

Distal pancreatectomy with celiac axis resection (DP-CAR) is performed for locally advanced pancreatic body cancers involving the common hepatic artery (CHA) and/or celiac axis (CA). This procedure becomes especially intractable in cases of portal vein (PV) invasion due to poor mobility around both the CA and PV. However, no previous reports have described the surgical strategies for such difficult situations. To overcome the difficulty of CA and PV invasion, we devised a novel procedure called "pre-resection portal vein reconstruction." In this procedure, PV reconstruction using an inferior mesenteric vein patch graft is implemented after division of the CHA and pancreatic neck. The greatest advantage of this procedure is improved mobility around the pancreatic body after PV reconstruction, thereby enabling a subsequent sequential approach around the superior mesenteric artery, abdominal aorta, and CA root. "Pre-resection portal vein reconstruction" is an option for locally advanced pancreatic body cancers with both CA and PV invasion.