Pancreaticoduodenectomy With Venous Resection: An Analysis of 30-Day Morbidity and Mortality

Abstract

BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.

Preoperative In-Hospital Rehabilitation Improves Physical Function in Patients with Pancreatic Cancer Scheduled for Surgery

“…In general, preoperative physical function in cancer patients correlate with postoperative complications, duration of hospitalization, and prognosis (Karlsson et al 2018;Patel et al 2019). Particularly in patients with pancreatic cancer, who receive pre and/or postoperative chemotherapy and highly invasive surgery, the risk of poor postoperative outcomes is a major concern (Callejas et al 2019). Therefore, it would be beneficial to improve preoperative physical function especially in patients with pancreatic cancer.…”

Postoperative Outcomes of Tangential versus Segmental Resection and End-to-end Reconstruction of the Superior Mesenterico-Portal Vein During Pancreatoduodenectomy for Pancreatic Adenocarcinoma: A Single-Center Experience

“…Zettervall et al could not detect an increase in postoperative mortality or morbidity in patients with PVR as compared to those without PVR (37). Callejas et al also failed to find an association between resections of the portal vein, the superior mesenteric vein or the venous confluens and patient morbidity (38). Ramacciatio et al reported that the use of preoperative biliary drainage was related to postoperative morbidity but PVR was not (39).…”

The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection—a retrospective study

“…In specialized centers, double-digit mortality rates are a thing of the past. Nevertheless, morbidity is still high and surgical complications are the main issue [ 1 – 3 ]. In patients with preoperative biliary drainage (PBD), the risk of postoperative infectious complications may be even elevated [ 4 , 5 ].…”