Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation

Serotonin [5-hydroxytryptamine (5-HT)] causes relaxation of the isolated superior mesenteric vein, a splanchnic blood vessel, through activation of the 5-HT7 receptor. As part of studies designed to identify the mechanism(s) through which chronic (≥24 h) infusion of 5-HT lowers blood pressure, we tested the hypothesis that 5-HT causes in vitro and in vivo splanchnic venodilation that is 5-HT7 receptor dependent. In tissue baths for measurement of isometric contraction, the portal vein and abdominal inferior vena cava relaxed to 5-HT and the 5-HT1/7 receptor agonist 5-carboxamidotryptamine; relaxation was abolished by the 5-HT7 receptor antagonist SB-269970. Western blot analyses showed that the abdominal inferior vena cava and portal vein express 5-HT7 receptor protein. In contrast, the thoracic vena cava, outside the splanchnic circulation, did not relax to serotonergic agonists and exhibited minimal expression of the 5-HT7 receptor. Male Sprague-Dawley rats with chronically implanted radiotelemetry transmitters underwent repeated ultrasound imaging of abdominal vessels. After baseline imaging, minipumps containing vehicle (saline) or 5-HT (25 μg·kg−1·min−1) were implanted. Twenty-four hours later, venous diameters were increased in rats with 5-HT-infusion (percent increase from baseline: superior mesenteric vein, 17.5 ± 1.9; portal vein, 17.7 ± 1.8; and abdominal inferior vena cava, 46.9 ± 8.0) while arterial pressure was decreased (~13 mmHg). Measures returned to baseline after infusion termination. In a separate group of animals, treatment with SB-269970 (3 mg/kg iv) prevented the splanchnic venodilation and fall in blood pressure during 24 h of 5-HT infusion. Thus, 5-HT causes 5-HT7 receptor-dependent splanchnic venous dilation associated with a fall in blood pressure. NEW & NOTEWORTHY This research is noteworthy because it combines and links, through the 5-HT7 receptor, an in vitro observation (venorelaxation) with in vivo events (venodilation and fall in blood pressure). This supports the idea that splanchnic venodilation plays a role in blood pressure regulation.

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Splenic vein reconstruction is unnecessary in pancreatoduodenectomy combined with resection of the superior mesenteric vein–portal vein confluence according to short-term outcomes

HPB ◽

10.1016/j.hpb.2017.02.438 ◽

2017 ◽

Vol 19 (9) ◽

pp. 785-792 ◽

Cited By ~ 14

Author(s):

Haruyoshi Tanaka ◽

Akimasa Nakao ◽

Kenji Oshima ◽

Kiyotsugu Iede ◽

Yukiko Oshima ◽

...

Keyword(s):

Portal Vein ◽

Superior Mesenteric Vein ◽

Splenic Vein ◽

Short Term ◽

Mesenteric Vein

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Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

The American Surgeon ◽

10.1177/000313480507101013 ◽

2005 ◽

Vol 71 (10) ◽

pp. 856-860 ◽

Cited By ~ 10

Author(s):

George A. Poultsides ◽

W. Cannon Lewis ◽

Robert Feld ◽

David L. Walters ◽

David A. Cherry ◽

...

Keyword(s):

Portal Vein ◽

Thrombolytic Therapy ◽

Venous Thrombosis ◽

Portal Vein Thrombosis ◽

Superior Mesenteric Vein ◽

Right Hemicolectomy ◽

Published Data ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Laparoscopic Assisted

Portal vein thrombosis is a rare but well-reported complication after laparoscopic surgery. We present a case of portomesenteric venous thrombosis that occurred 8 days after a laparoscopic-assisted right hemicolectomy. Systemic anticoagulation failed to improve symptoms. The early postoperative state precluded the use of transarterial thrombolytic therapy. Transjugular intra-hepatic catheter-directed infusion of urokinase into the superior mesenteric vein resulted in clearance of thrombus and resolution of symptoms. The published data on laparoscopy-induced splanchnic venous thrombosis and transjugular intrahepatic intramesenteric thrombolysis are discussed.

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Contribution of Superior Mesenteric Vein Flow to the Right and Left Lobes of the Liver Using CFD

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206254 ◽

2009 ◽

Author(s):

Stephanie M. George ◽

Diego R. Martin ◽

Don P. Giddens

Keyword(s):

Portal Vein ◽

Superior Mesenteric Vein ◽

Splenic Vein ◽

Normal Subjects ◽

Diagnostic Techniques ◽

Mesenteric Vein ◽

Right Lobe ◽

Computational Fluid Dynamics Cfd ◽

The Right ◽

End Stage

The incidence of cirrhosis, the end stage for many liver diseases, is rising and with it the need for better understanding of the progression of the disease and diagnostic techniques. The authors have noted that liver disease occurs preferentially in the right side of the liver which is the largest lobe. One hypothesis is that this is due to the composition of the blood that supplies the right lobe. The liver is fed by both the hepatic artery and the portal vein with the portal vein contributing about 80% of the blood supply. The portal vein (PV) is supplied by the superior mesenteric vein (SMV), which drains blood from the digestive track, and the splenic vein (SV), which drains blood from the spleen. Since the blood in the SMV is coming from the digestive track, it carries toxins and items absorbed during digestion. Toxins such as alcohol are known to damage the liver. Thus, our hypothesis is that the majority of the SMV flow feeds into the right portal vein and ultimately the right lobe of the liver. This study seeks to assess the validity of our hypothesis in four subjects by creating subject specific models in two normal subjects and two patients and using computational fluid dynamics (CFD) to calculate the SMV contribution to the right portal vein.

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Can post-hoc video review of robotic pancreaticoduodenectomy predict portal/superior mesenteric vein margin status in pancreatic adenocarcinoma?

HPB ◽

10.1016/j.hpb.2018.10.012 ◽

2019 ◽

Vol 21 (6) ◽

pp. 679-686 ◽

Cited By ~ 1

Author(s):

Jae P. Jung ◽

Mazen S. Zenati ◽

Ahmad Hamad ◽

Melissa E. Hogg ◽

Richard L. Simmons ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Superior Mesenteric Vein ◽

Margin Status ◽

Mesenteric Vein ◽

Video Review ◽

Robotic Pancreaticoduodenectomy ◽

Post Hoc

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A Case of Superior Mesenteric Vein and Portal Vein Thrombosis Associated with Normal Delivery Presented by Acute Pancreatitis

Ewha Medical Journal ◽

10.12771/emj.2008.31.1.41 ◽

2008 ◽

Vol 31 (1) ◽

pp. 41

Author(s):

Youn Ju Na ◽

Min Jung Kang ◽

Ji Min Jung ◽

Chang Yoon Ha ◽

Hae Sun Jung ◽

...

Keyword(s):

Acute Pancreatitis ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Superior Mesenteric Vein ◽

Normal Delivery ◽

Mesenteric Vein ◽

Vein Thrombosis

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Superior Mesenteric-Portal Vein Resection in Patients With Pancreatic Adenocarcinoma Is Safe and May Increase Survival

International Surgery ◽

10.9738/intsurg-d-15-00096.1 ◽

2017 ◽

Vol 102 (7-8) ◽

pp. 356-361

Author(s):

Wei-Ding Wu ◽

Hong-Guo Yang ◽

Jia Wu ◽

Kai Jiang ◽

Kun Guo ◽

...

Keyword(s):

Portal Vein ◽

Pancreatic Adenocarcinoma ◽

Survival Rates ◽

Vein Wall ◽

Venous Resection ◽

Group A ◽

Tumor Involvement ◽

Artery First ◽

Vein Resection ◽

Group B

Extension of pancreatic adenocarcinoma into adjacent vasculature often necessitates resection of the portal vein (PV) and or superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD). Our study describes the surgical technique and results of PV/SMV resection in pancreatic adenocarcinoma patients. Between January 2008 and October 2013, 252 patients underwent PD for pancreatic malignancy. A total of 42 PV/SMV resections were performed (28 men, 14 women). Patients were categorized into 2 groups according to the degree of invasion into the portal vein wall: Group A (n = 16), extended compression of the portal vein wall by the surrounding carcinoma without true invasion, and Group B (n = 26), true invasion including intramural and transmural invasion. Morbidity of the 42 patients was 35%; there was no operative mortality, and overall 1-, 3-, and 5-year survival rates were 60%, 21%, and 12%, respectively. No differences in tumor size, margin positivity, nodal positivity, or survival rates were observed between groups. Resection of the PV/SMV is safe and does not increase morbidity or mortality. Tumor involvement of the PV/SMV is not associated with histopathologic signs that are predictive of a poor prognosis. The “artery first” approach should be considered as a means to facilitate safe venous resection and reconstruction.

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