Background: The rising diffusion of vascular resections during complex pancreatectomy for malignancy, for both oncological and technical matters, brought with it the use of vascular shunts, either temporary or definitive, to prevent bowel congestion and liver ischemia. This study aimed to systematically review the literature on the technical feasibility of vascular shunts during advanced pancreatic surgery, analyzing intraoperative and postoperative outcomes. Methods: A systematic literature search was performed on PubMed, Scopus, Web of Science, and the Cochrane Library Central, according to PRISMA guidelines. Studies published before 2006 were excluded, considering the lack of a standardized definition of locally advanced pancreatic cancer. The main outcomes evaluated were the overall complication rate and shunt patency. Results: Among 789 papers retrieved from the database search, only five fulfilled the inclusion criteria and were included in the review, amounting to a total of 145 patients undergoing a shunt creation at the time of pancreatectomy. Pancreatic adenocarcinoma (PDAC) was found to be the most common diagnosis and pancreaticoduodenectomy was the main surgical procedure, accounting for 88% and 83% of the overall cohort, respectively. The distal splenorenal shunt was the most performed. Overall, 44 out of 145 patients (30%) experienced postoperative complications; the long-term patency of definitive shunts was 83% (110 out of 120 patients). Conclusions: An increasing number of patients with borderline resectable or locally advanced PDAC are becoming amenable to resection and shunt creation may facilitate vascular resection with clear margins, becoming a valid tool of modern pancreatic surgery.
背景：在针对恶性肿瘤的复杂胰腺切除术中，出于肿瘤学和技术考量，血管切除的应用日益增多，随之而来的是采用临时性或永久性血管分流术来预防肠道淤血和肝脏缺血。本研究旨在系统回顾关于晚期胰腺手术中血管分流术技术可行性的文献，分析其术中及术后结果。方法：根据PRISMA指南，在PubMed、Scopus、Web of Science和Cochrane图书馆中心进行系统性文献检索。考虑到局部晚期胰腺癌缺乏标准化定义，排除了2006年之前发表的研究。评估的主要结果是总体并发症发生率和分流通畅率。结果：在数据库检索到的789篇文献中，仅5篇符合纳入标准并被纳入综述，共计145例患者在胰腺切除术中接受了分流术建立。胰腺腺癌（PDAC）是最常见的诊断，胰十二指肠切除术是主要手术方式，分别占整体队列的88%和83%。远端脾肾分流术是最常实施的手术。总体而言，145例患者中有44例（30%）出现术后并发症；永久性分流术的长期通畅率为83%（120例患者中有110例）。结论：越来越多的临界可切除或局部晚期PDAC患者适合接受切除术，而分流术的建立可能有助于实现切缘阴性的血管切除，正成为现代胰腺外科的有效工具。
Use of Vascular Shunt at the Time of Pancreatectomy with Venous Resection: A Systematic Review
肿瘤(癌症)患者之家