Complex Pancreatic Ressections with Vascular Involvement in Jehovah's Witnesses: How to Approach?

Pancreatic cancer surgery is a technical challenge to the modern abdominal surgeon. Vascular resections, especially venous resections, have become frequent in specialized centers, accounting for 15-70% of duodenopancreatectomies and Appleby procedures for adenocarcinoma11. In Brazil, pancreatic cancer represents the seventh cause of death due to neoplasm in men and the sixth in women9. The religious group of Jehovah’s Witnesses (JW) includes more than 1.3 million followers in Brazil, being the third largest JW community in the world, after the United States and Mexico, representing approximately 0.5% of the Brazilian population2. The medical class faces ethical and legal challenges in the treatment of these patients, since this group refuses to receive blood transfusion or its components, often meeting with a medical duty to save lives. This ethical and legal dilemma causes many medical teams to refuse to perform surgical procedures in JW patients4. Large operations, such as cardiovascular, thoracic, abdominal and organ transplants, have been performed in JW in a timid manner, with few citations in the literature. The principle of bloodless surgery, originally designed to rationalize the use of blood transfusions, was subsequently successfully applied to this population group, thanks to the advent of faster, more precise sealants, haemostatic agents and surgical techniques4. ABCD Arq Bras Cir Dig letter to the editor 2016;29(4):291-212