Portal Vein Stenosis Following Neoadjuvant Therapy With MRgART and Surgery for Pancreatic Cancer: A Case Report

Abstract

Abstract Portal vein stenosis (PVS) is a rare but potentially devastating complication arising after definitive treatment of pancreatic cancer. The condition can manifest as symptomatic ascites, abdominal pain, splenomegaly, thrombocytopenia, as well as hemorrhage secondary to gastric or esophageal varices. The etiology is often multifactorial but has been associated with tumor progression, chemotherapy, vascular surgery, and radiation. We present a case in which a man with borderline-resectable pancreatic cancer developed symptomatic ascites secondary to PVS following treatment with neoadjuvant chemotherapy and subsequent 5-fraction MRI-guided adaptive radiation therapy and pancreaticoduodenectomy with vascular reconstruction. Though the incidence of PVS after ablative radiation therapy and surgery for pancreatic cancer appears to be low, it may be under-reported, and patients should be closely monitored in the setting of re-irradiation or planned vascular reconstruction. These findings may help inform future radiation therapy treatment planning guidelines to avoid excessive dose to the portal vein.