Redirecting venous flow from the superior mesenteric vein to the inferior mesenteric vein in resections for locally advanced pancreatic cancer

To evaluate the outcome of ligation of the superior mesenteric vein (SMV) and redirection the venous flow through the inferior mesenteric vein (IMV) in selected patients with pancreatic cancer. Radical surgery is the only potentially curable treatment of pancreatic cancer. Tumor-invasion of the SMV and its attributes will in some cases make it impossible to reconstruct the venous flow. Consecutive patients with pancreatic cancer operated between January 2019 and December 2022 were included. Selected patients eligible for venous flow reversal after systemic chemotherapy were offered surgical exploration. Eleven patients were offered surgery and nine of these went through radical resection with redirection of the venous flow through the IMV. True histological R0 resection was achieved in 6 (67%) patients. No 30- nor 90-days mortality was recorded. Median overall survival was 23.2 ± 11.5 months. Redirecting venous flow through the IMV while sacrificing the SMV during pancreatic resection is a safe procedure and may provide the opportunity for curative resection in otherwise unresectable patients.