Case Report
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World J Gastroenterol. Apr 28, 2013; 19(16): 2569-2573
Published online Apr 28, 2013. doi: 10.3748/wjg.v19.i16.2569
Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer
Yosuke Tsuruga, Hirofumi Kamachi, Kenji Wakayama, Tatsuhiko Kakisaka, Hideki Yokoo, Toshiya Kamiyama, Akinobu Taketomi
Yosuke Tsuruga, Hirofumi Kamachi, Kenji Wakayama, Tatsuhiko Kakisaka, Hideki Yokoo, Toshiya Kamiyama, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
Author contributions: All authors gave substantial contributions to acquisition, analysis and interpretation of data and participated in writing the paper; Taketomi A gave final approval of the version to be published.
Correspondence to: Yosuke Tsuruga, MD, PhD, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan. ytsuruga@med.hokudai.ac.jp
Telephone: +81-11-7065927 Fax: +81-11-7177515
Received: December 5, 2012
Revised: February 8, 2013
Accepted: March 8, 2013
Published online: April 28, 2013
Processing time: 147 Days and 22.9 Hours
Abstract

Extrahepatic portal vein (PV) stenosis has various causes, such as tumor encasement, pancreatitis and as a post-surgical complication. With regard to post-pancreaticoduodenectomy, intraoperative radiation therapy with/without PV resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed NACRT in 18 patients with borderline resectable pancreatic cancer since 2005. Of the 15 patients who completed NACRT, nine had undergone pancreatectomy. Combined portal resection was performed in eight of the nine patients. We report here three patients with PV stenosis, and thus the ratio of post-operative PV stenosis in patients with PV resection following NACRT is 37.5% in this series. We encountered no case of PV stenosis among 22 patients operated with PV resection for pancreatobiliary cancer without NACRT during the same period. A relationship between PV stenosis and NACRT is suspected, but further investigation is required to determine whether NACRT has relevance to PV stenosis.

Keywords: Pancreatic cancer; Portal vein stenosis; Neoadjuvant chemoradiation therapy; Pancreatectomy; Expandable metallic stent

Core tip: Intraoperative radiation therapy for pancreatic cancer with/without portal vein (PV) resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed pancreatectomy with PV resection following NACRT in 8 patients with borderline resectable pancreatic cancer since 2005. The ratio of post-operative PV stenosis is 37.5% in this series.