RESUMO
Pancreatic neuroendocrine tumors (PNTs) are relatively uncommon although these neoplasms have been noted to grow in occurrence in recent decades. Surgical removal of locally advanced PNTs involving major vessels and adjacent organs is warranted by reason of an appreciably more favorable prognosis as compared to exocrine pancreas cancer. We are reporting a case of successful multi-organ resection combined with a wide excision of the superior mesenteric, common, proper, left and right hepatic arteries (in the presence of the hepatomesenteric trunk variant of aberrant arterial anatomy) for multifocal PNTs in the setting of multiple neuroendocrine neoplasia type 1 syndrome. The procedure resulted in pain abolition, a significant improvement in the patient's life quality and allowed her to return to work. Follow-up computed tomography at 15 mo post-surgery showed no evidence of disease recurrence.
RESUMO
CONTEXT: Knowing the collaterals is essential for a spleen-preserving distal pancreatectomy with resection of the splenic vessels. OBJECTIVE: To ascertain the sources of the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels. METHODS: Perfusion of the cadaveric left gastric and right gastroepiploic arteries with methylene blue after occlusion of all the arteries except the short gastric arteries (n=10). Intraoperative color Doppler ultrasound was used for the evaluation of the hilar arterial blood flow at distal pancreatectomy (n=23) after 1) clamping of the splenic artery alone, 2) clamping of the splenic and left gastroepiploic arteries and 3) clamping of the splenic and short gastric arteries. CT angiography of the gastric and splenic vessels before and after a spleen-preserving distal pancreatectomy (n=10). RESULTS: Perfusion of the cadaveric arteries revealed no effective direct or indirect (through the submucous gastric arterial network) communication between the left gastric and the branches of the short gastric arteries. In no case did intraoperative color Doppler ultrasound detect any hilar arterial blood flow after the clamping of the splenic and left gastroepiploic arteries. The clamping of the short gastric arteries did not change the flow parameters. In none of the cases did a post-spleen-preserving distal pancreatectomy with resection of the splenic vessels CT angiography delineate the short gastric vessels supplying the spleen. In all cases, the gastroepiploic arcade was the main arterial pathway feeding the spleen. CONCLUSION: Experimental, intra- and postoperative instrumental investigations did not show the short gastric arteries to be engaged in the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels. In all cases, the left gastroepiploic artery was the main collateral vessel.
