Rutherford's 195: Vascular Reconstruction in Oncologic Surgery скачать в хорошем качестве

Rutherford's 195: Vascular Reconstruction in Oncologic Surgery

#VascularReconstruction #OncologicSurgery #CancerTreatment #RutherfordVascular #SurgicalOncology #PancreaticCancer #LiverCancer #Sarcoma #LimbSalvage #PortalVein #HepaticArtery #IVC #ComplexSurgery #DeepDive #MedicalEducation This video provides a deep dive into vascular resection and reconstruction techniques used in modern cancer surgery, drawing insights from Rutherford's Vascular Surgery and Endovascular Therapy. It highlights how surgeons manage critical blood vessels while removing tumors. For pancreatic cancers, resectability is significantly impacted by tumor involvement of nearby vessels like the SMA, hepatic arteries, SMV, and portal vein. Borderline resectable tumors, where vessels are involved but reconstruction might be possible, often benefit from neoadjuvant therapy to shrink the tumor. If significant vascular involvement persists, vascular resection and reconstruction during pancreatectomy are necessary to offer a potential cure, yielding survival rates comparable to standard pancreatectomy for initially resectable tumours. Techniques include the artery-first approach to aid venous dissection and venous reconstruction via direct connection, patch repair (often saphenous vein), or interposition grafts (renal, jugular, splenic veins) depending on the defect size. Arterial resection is still controversial but performed at specialized centres for complete tumor removal. The Applebee procedure is a specific celiac axis resection for pancreatic body tumors, relying on collateral blood flow. In hepatic and biliary malignancies, particularly Hilar cholangiocarcinoma (Klatskin tumors), vessel involvement (portal vein, hepatic artery, IVC) is common. Achieving R0 resection often requires complex resections and reconstruction, primarily of the portal vein, but increasingly the hepatic artery and IVC at high-volume centres. Preoperative planning is essential. Portal vein reconstruction typically involves primary anastomosis or grafts (autologous veins preferred). Outcomes for hepatic artery and IVC reconstruction have improved in experienced hands. For soft tissue sarcomas, vascular reconstruction is crucial for limb salvage when vessels are involved. Arterial reconstruction is always needed, often using a GSV bypass graft, resulting in high limb salvage rates. Venous reconstruction is debated, with ligation sometimes possible if collateral drainage is adequate. Complex retroperitoneal sarcomas often require resection and synthetic graft reconstruction of the aorta or IVC. Achieving R0 resection is vital for long-term outcomes across all these cancers. These complex procedures demonstrate the evolution of surgical oncology and require close multidisciplinary collaboration. Venous reconstruction is increasingly safe, while arterial work remains challenging but feasible in expert hands.