胰腺癌累及血管精准切除重建技术及评价OA

Pancreatic cancer is often ineligible for upfront surgery at diagnosis due to vascular involvement.Under the precision surgery paradigm,resectability assessment should shift from anatomical to biological criteria,and from"resectability"to"reconstructability",with dynamic evaluation of tumor biology guiding optimal surgical timing.Preoperative precision vascular assessment is essential for individualized surgical planning.Venous reconstruction techniques are well established.Splenic vein reconstruction is recommended for involvement of the spleno-portal confluence.Low-level venous involvement remains challenging,multi-branch reconstruction of the jejunal venous trunks can be achieved via vascular plastic techniques,while extensive low-level involvement may necessitate ex vivo resection with intestinal autotransplantation.Graft interposition should be avoided whenever possible;the Cattell-Braasch maneuver enables graft-free end-to-end anastomosis for long-segment venous resection.Arterial resection and reconstruction,though technically demanding and associated with significant perioperative risks,confers a survival benefit in patients with a favorable response to conversion therapy.Arterial divestment and resection have been proven safe and feasible in high-volume centers.The venous bypass-first strategy improves safety in complex cases with portal vein occlusion and cavernous transformation.Precise preoperative planning and vascular reconstruction techniques,and standardized surgical strategies are key to improving the safety and radicality of pancreatic cancer surgery.Future efforts should focus on promoting standardized surgical protocols and training systems to benefit more patients with vascular involvement.