Trends in indications, complications and outcomes for venous resection during pancreatoduodenectomy

Abstract

Despite an initial improvement in severe complications for venous resection during pancreatoduodenectomy, this was not maintained over time. Every fourth patient with venous resection needed relaparotomy, most frequently for bleeding.

Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor

“…An increasing number of patients with locally advanced disease or borderline resectable tumors are offered surgery by means of concomitant vascular resection of the portal vein or superior mesenteric vein. 1,2 In the presence of arterial involvement, neo-adjuvant chemotherapy is advocated to improve the possibility of resection. 3 For jaundiced patients with resectable pancreatic cancer, surgery rather than preoperative biliary drainage is advocated to relieve biliary obstruction.…”

Improving outcomes in patients with resectable pancreatic cancer

“…Resection of the superior mesenteric vein/portal vein is routine in some centres, where patient survival is equivalent to that of patients who undergo resection with no vascular involvement 5 . Ravikumar and colleagues 5 and Kleive et al 6 , however, report a need for relaparotomy among between 7 and 24 per cent of patients in this group. There is little understanding of the institutional or geographical variation in this practice, which is largely influenced by local experience, centre volume and dogma.…”

“…Resection of the superior mesenteric vein/portal vein is routine in some centres, where patient survival is equivalent to that of patients who undergo resection with no vascular involvement. Ravikumar and colleagues and Kleive et al ,. however, report a need for relaparotomy among between 7 and 24 per cent of patients in this group.…”

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

“…However, more recent data have shown that a venous resection during pancreatic resections for PDAC is associated with increased rates of complications (41)(42)(43)(44). A posterior or a mesenteric approach appears to facilitate a venous resection and reconstruction during pancreatico-duodenectomies for PDAC (7,27,45,46).…”