A Safe Technique for Radical Antegrade Modular Pancreatosplenectomy with Venous Resection for Pancreatic Cancer

Pancreatic resections for pancreatic cancer involving the portal vein (PV) or the superior mesenteric vein (SMV)(1) are performed with an en-bloc resection of the PV-SMV axis.(2,3) The superior mesenteric artery (SMA) first approach is recommended for these cases.(4-8) In this surgical technique, the retroportal lamina along the SMA is resected before the venous resection is performed to leave the tumoral specimen attached exclusively to the area of vascular invasion on the mesenterico-portal (MP) axis. This procedure allows the venous resection and reconstruction to be performed safely and with limited venous clamping time. Most studies have focused on major venous resections during pancreaticoduodenectomy. Pancreatosplenectomy with PV resection is under-reported and represents 0% to 4% of the cases in major series.(9-12) Pancreatosplenectomy with PV resection requires an appropriate surgical technique to be performed safely. Unlike pancreaticoduodenectomy, the venous resection and reconstruction during pancreatosplenectomy can be difficult because of the distance between the 2 venous stumps, and it may require prolonged clamping of the venous axis. The oncologic principles of radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer, established by Strasberg and colleagues(11) and Mitchem and associates,(12) should be respected. We report our technique for safely performing RAMPS with an en-bloc MP axis resection.