Multi-institutional study of outcomes from portal vein reconstruction during pancreatic cancer surgery

Portal vein reconstruction (PVR) is undertaken to enhance resectability during pancreatic cancer surgery. We hypothesize that the type of reconstructions for patients undergoing PVR may not significantly influence overall outcomes.

Patients undergoing PVR for pancreatic cancer surgery (2013-2023) were identified at three academic institutions. χ² and Kaplan-Meier analyses were used to evaluate outcomes.

Eighty patients were captured, with 53% men and 45% women. Preoperative chemoradiation was undertaken in 70% of patients. Pancreaticoduodenectomy was undertaken in 79 patients (92%), with distal pancreatectomy in one (1.2%). Primary repair was undertaken in 46 patients (58%), bovine patch in 22 (28%), other vein patch in two (3%), with interposition conduits such as the internal jugular vein, great saphenous vein, superficial femoral vein, and PTFE in 10 (13%). Thirty-day complications included four deaths (5%), one stroke (1.3%), and one major adverse cardiac event (1.3%). Overall complications included death in 45 patients (56%), mesenteric ischemia in one (1.3%), and reintervention in one patient (1.3%). Postoperative medications included aspirin in 43 patients (54%), clopidogrel in one (1.3%), dual antiplatelet therapy in three (4%), and anticoagulation in 17 (21%). Over 21 months mean follow-up, 18 reconstructions (23%) occluded, with three (4%) reintervened upon at a mean of 6.3 months from index procedure with no association with type of repair. At 36 months, estimated survival was 66%, of which primary patency in survivors was 78%.

PVR during pancreatic cancer surgery is safe and durable. One-quarter of all reconstructions fail at medium-term follow-up, and very few require reintervention for clinical symptoms. Although primary repair has been suggested as the most optimal reconstruction, our findings imply that long-term patency of PVR may not be clinically important. Furthermore, outside of infectious considerations, it is likely that conduit or reconstruction type does not affect outcome.