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Simple Summary: Radical pancreatectomies with superior mesenteric vein (SMV) resection without portal-to-superior mesenteric vein (PV/SMV) reconstruction are scarcely discussed in the literature. The existing data contain around 15 cases published with unclear oncological results and algorithms of patients' selection. In the present report, we analyzed the short- and long-term results of 19 consecutive pancreatectomies with SMV resection without PV/SMV reconstruction for locally advanced pancreatic ductal adenocarcinoma, and discussed the role of CT-based preoperative reconstructions and selection criteria for radical and safe surgery in this highly specific group of patients. The "vein definition" for locally advanced pancreatic ductal adenocarcinoma (LA PDAC) assumes portal-to-superior mesenteric vein (PV/SMV) unreconstructability due to tumor involvement or occlusion. Radical pancreatectomies with SMV resection without PV/SMV reconstruction are scarcely discussed in the literature. Retrospective analysis of 19 radical pancreatectomies for "low" LA PDAC with SMV and all its tributaries resection without PV/SMV reconstruction has shown zero mortality; overall morbidity—56%; Dindo–Clavien—3–10.5%; R0—rate—82%; mean operative procedure time—355 ± 154 min; mean blood loss—330 ± 170 mL; delayed gastric emptying—25%; and clinically relevant postoperative pancreatic fistula—8%. In three cases, surgery was associated with superior mesenteric (n2) and common hepatic artery (n1) resection. Surgery was completed without vein reconstruction (n13) and with inferior mesenteric-to-splenic anastomosis (n6). There were no cases of liver, gastric, or intestinal ischemia. A specific complication of the SMV resection without reconstruction was 2–3 days-long intestinal edema (48%). Median overall survival was 25 months, and median progression-free survival was 18 months. All the relapses, except two, were distant. The possibility of successful SMV resection without PV/SMV reconstruction can be predicted before surgery by CT-based reconstructions. The mandatory anatomical conditions for the procedure were as follows: (1) preserved SMV-SV confluence; (2) occluded SMV for any reason (tumor or thrombus); (3) well-developed inferior mesenteric vein collaterals with dilated intestinal veins; (4) no right-sided vein collaterals; and (5) no varices in the upper abdomen. Conclusion: "Low" LA PDACs involving SMV with all its tributaries can be radically and safely resected in highly and specifically selected cases without PV/SMV reconstruction with an acceptable survival rate. [ABSTRACT FROM AUTHOR]

Frey procedure is one of the most common surgical treatment options for chronic pancreatitis. The data on safety and effectiveness of laparoscopic approach in Frey procedure are very limited. In the present study a comparative analysis of the short- and long-term outcomes of laparoscopic versus open Frey procedure was demonstrated. Seventy-nine consecutive patients with chronic pancreatitis submitted to either open (n – 29) (OFP) or laparoscopic (n – 50) (LFP) Frey procedure between September 2012 and January 2020, were evaluated. The laparoscopic approach was performed fully on 45 (90%) patients. Conversion was needed in 4 (8%) cases, 1 patient (2%) was converted to laparoscopic Beger procedure. The median operative time was 420 (290–685) min after LFP and 310 (179–515) min after OFP. The blood loss was 100 (30–700) ml and 225 (50–1200) ml, respectively. The pain score on POD 3 was 2 (1–4) in LFP group and 4 (2–8) after OFP. The length of hospital stay was 6 (3–25) days after LFP and 9.5 (5–42) days after OFP. In the LFP and OFP groups the postoperative complications occurred in 11 (24.4%) and 8 (28.5%) patients, respectively. The follow-up period lasted for 36 (6–60) months after LFP and 60 (6–60) months after OFP. Poor pain control with the need for non-opioid analgesics intake was observed in 4 patients in the LFP group and in 3 patients after OFP. Laparoscopic Frey procedure is an efficient and safe intervention, which provides all the advantages of the minimally invasive approach. [ABSTRACT FROM AUTHOR]

Simple Summary: Distal pancreatectomy with the celiac artery resection (DPCAR) is an oncologically justified procedure for locally advanced pancreatic ductal adenocarcinoma (PDAC). The results of its use in our selective group of 40 consecutive patients demonstrated a high rate of R0-resections, acceptable morbidity, and survival better than that for resectable PDAC. The unsolved problems of this procedure are the liver and stomach ischemic complications, which can be lethal or lead to prolonged hospital stay and deterioration in survival. The existing clinical data do not explain the mechanisms of these specific complications in sufficient detail and can't be used for their prognosis and prevention. We have studied the correlation of clinical data and hemodynamic changes of the collateral arteries in a series of technically homogeneous procedures. The geometrical changes of the pancreatoduodenal arcade elements after DPCAR could explain the causes of ischemic complications after surgery and determine the directions for their prevention. DPCAR's short- and long-term outcomes are highly diverse, while the causes and prevention of ischemic complications are unclear. To assess oncological, surgical, and hemodynamic outcomes of 40 consecutive DPCARs for pancreatic (n37) and gastric tumors (n3) (2009–2021), retrospective analyses of mortality, morbidity, survival, and hemodynamic consequences after DPCAR were undertaken using case history data, IOUS, and pre- and postoperative CT measurements. In postoperative complications (42.5%), the pancreatic fistula was the most frequent event (27%), 90-day mortality was 7.5. With 27 months median follow-up, median overall (OS) and progression-free survival (PFS) for PDAC were 29 and 18 months, respectively; with 1-, 3-, and 5-years, the OS were 90, 60, and 28%, with an R0-resection rate of 92.5%. Liver and gastric ischemia developed in 0 and 5 (12.5%) cases. Comparison of clinical and vascular geometry data revealed fast adaptation of collateral circulation, insignificant changes in proper hepatic artery diameter, and high risk of ischemic gastropathy if the preoperative diameter of pancreaticoduodenal artery was <2 mm. DP CAR can be performed with acceptable morbidity and survival. OS and RFS in this super-selective cohort were compared to those for resectable cancer. The changes in the postoperative arterial geometry could explain the causes of ischemic complications and determine directions for their prevention. [ABSTRACT FROM AUTHOR]