Chapter 195 - Vascular reconstruction in oncologic surgery

Question 1

Pancreatic cancer resectability classification

Answer 1

1) unresectable
2) borderline resectable
3) resectable

Question 2

Definition of unresectable pancreatic cancer

Answer 2

metastatic disease

encasement of SMA or HA and no venous reconstruction

Question 3

Definition of borderine resectable pancreatic cancer

Answer 3

> 180 degree SMV PV

< 180 degree SMA CA

Question 4

Vascular reconstruction in pancreaticoduodenectomy principles

Answer 4

1) ligate SMA branches to pancreas first
2) divide SMA connection to uncinate process
3) expose lateral border of PV/SMV

Question 5

Maximum gap in PV that may still be repaired with primary anastamosis

Answer 5

3 cm

Question 6

How to mobilize for maximum PV length for primary reconstruction

Answer 6

1) releasing triangular and cardinal ligatments along with hepatocolic and falciform ligaments
2) mobilize midgut by dissecting anterior to aorta and ivc
3) ligate all branches of the PV and SMV

Question 7

Size of the airknot to be employed when finishing PV anastamosis

Answer 7

1/3 diameter of PV

Question 8

Venous conduits for PV reconstruction

Answer 8

renal vein
IJ
GSV
FV

Question 9

Appleby procedure

Answer 9

Celiax axis resection after ensuring GDA perfuses hepatic adequately

Question 10

Klatskin tumour

Answer 10

Hilar cholangiocarcinoma

Question 11

Most common cancer in biliary tree

Answer 11

Cholangiocarcinoma 3% of all GI cancer

50-70% present with curative resection potential

Question 12

Maximum liver resection allowed

Answer 12

> 0.6% of total body weight

Question 13

Portal vein embolization for tumors indication and timing

Answer 13

If borderling future liver remnant anticipated

4-6 weeks before resection

Question 14

Hepatic artery reconstruction

Answer 14

historically frowned upon but now mortality rates have increased from 55% to 2% perioperative

5 year survival 30%

Question 15

Infection risk in using PTFE in IVC reconstruction

Answer 15

no clear evidence

Question 16

Soft tissue sarcoma reconstruction on patency of graft

Answer 16

same as that for atherosclerotic disease

Question 17

Most common location of soft tissue sarcoma

Answer 17

Extremity 47%

Question 18

Local recurrence of soft tissue sarcoma

Answer 18

16%

Question 19

Retroperitoneal STS occurrence

Answer 19

15% of all sarcoma

Question 20

Risk of significant extremity edema after IVC ligation

Answer 20

50%

Question 21

First line graft choice in aortic and IVC reconstruction after retroperitoneal STS resection

Answer 21

prosthetic grafts