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Pancreatectomy with vein reconstruction: technique matters
Monica M Dua1, Thuy B Tran1, Jill Klausner2
1Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
Summary
For portal vein (PV) and/or superior mesenteric vein (SMV) reconstruction during pancreatectomy, primary end-to-end and transverse venorrhaphy (TV) techniques show superior patency rates compared to other methods. These findings suggest preferred strategies for short vein reconstructions.
Area of Science:
- Surgical Oncology
- Vascular Surgery
- Gastrointestinal Surgery
Background:
- Portal vein (PV) and/or superior mesenteric vein (SMV) resection/reconstruction is performed during pancreatectomy.
- The optimal surgical strategy for these complex reconstructions remains unclear.
Purpose of the Study:
- To evaluate the outcomes of different surgical techniques for PV/SMV resection/reconstruction during pancreatectomy.
- To identify techniques associated with superior patency rates and reduced thrombosis.
Main Methods:
- Retrospective review of 90 patients undergoing PV/SMV resection/reconstruction during pancreatectomy (2005-2014).
- Analysis of operative details and outcomes, focusing on vein patency.
- Comparison of five techniques: longitudinal venorrhaphy (LV), transverse venorrhaphy (TV), primary end-to-end, patch venoplasty (PV), and interposition graft (IG).
Main Results:
- Overall thrombosis rate was 18% (16/90) with a median follow-up of 316 days.
- Primary end-to-end and TV techniques demonstrated 100% patency.
- LV, PV, and IG techniques were associated with significantly higher rates of thrombosis (P = 0.001).
- Prophylactic aspirin use did not show a protective benefit against thrombosis.
Conclusions:
- Primary end-to-end and TV techniques offer superior patency rates after PV/SMV resection.
- These methods should be preferred for short (<3 cm) vascular reconstructions during pancreatectomy.
