Comparison of patency rates and clinical impact of different reconstruction methods following portal/superior mesenteric vein resection during pancreatectomy

Gao, Wentao; Dai, Xinglong; Dai, Chunsun; Jiang, Kuirong; Wu, Junli; Li, Qiang; Guo, Feng; Chen, Jianmin; Wei, Jishu; Lu, Zheng; Tu, Min

doi:10.1016/j.pan.2016.09.010

Cited by 24 publications

(17 citation statements)

References 42 publications

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“…Thus, a systematic review published in 2014 did not show any significant differences of early PV thrombosis rates in patients with pancreatectomies and vascular resection with or without anticoagulation therapy (27). However, it seems that a portal venous thrombosis is more likely to appear when prosthetic grafts are used (27,28). In the present cohort, early portal venous thrombosis occurred in 5% of patients, out of what 3 patients underwent venous reconstruction with prosthetic graft interposition.…”

Section: Discussioncontrasting

confidence: 43%

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Dumitraşcu¹,

Martiniuc²,

Brasoveanu³

et al. 2018

chr

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Invasion of portal vein (PV)/ superior mesenteric vein (SMV) in pancreatic ductal adenocarcinoma (PDAC) is no longer a contraindication for resection when reconstruction is technically feasible. However, the literature data reached conflicting conclusions regarding the early and long-term outcomes of patients with venous resection and pancreatectomies for PDAC. The study aims to present the outcomes in a large series of patients with pancreatectomies and associated PV/ SMV resection for PDAC, in a single center experience. The data of 100 patients with pancreatectomies and PV and/ or SMV resection performed between 2002 and 2016 (February, 1st) were retrospectively analyzed from a prospectively maintained electronic database, which included 474 pancreatectomies for PDAC. Only patients with a final pathological diagnosis of PDAC were included in the present study. Overall, 21.1% of patients with pancreatectomies for PDAC required a venous resection (100 patients out of 474 patients). Segmental resection was performed in 77 patients (out of 100 patients with pancreatectomies and venous resection - 77%), while 23 patients (23%) have had tangential venous resection. In the group of patients with segmental venous resection, reconstruction was made by end-to-end anastomosis in 53 patients (out of 77 patients - 68.8%), while in 24 patients (out of 77 patients - 31.2%) a graft interposition was necessary. Negative resections margins were obtained in 63 patients (63%). Histological tumor invasion of the resected vein was confirmed in 64 patients (64%). Postoperative complications occurred in 47 patients (47%), with severe complications (i.e., Dindo-Clavien grade III-V) in 19 patients (19%). Postoperative pancreatic fistulae, delayed gastric emptying and post-pancreatectomy hemorrhage rates were 9%, 20% and 15%, respectively. PV/ SMV thrombosis occurred in 5 patients (5%). The 90-day mortality rate in the group of patients with venous only resection, without any associated procedures, was 8%. Adjuvant treatment was performed in 63 patients (63%), while only 2 patients (2%) underwent neoadjuvant chemotherapy. Median follow-up time was 105 months (range, 3 - 186 months), with a median overall survival time of 13 months (range, 3 - 186 months). In the group of patients with negative resection margins, the median overall survival time was 16 months (range, 3 - 186 months). PV/ SMV resection during pancreatectomies for PDAC is technically feasible, and grafts are rarely required for venous reconstruction. However, venous resection is associated with high postoperative complications rates, and the mortality rate is not neglectable. The main goal of such complex procedure is to obtain negative resection margins, a situation associated with encouraging survival rates.

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Section: Discussioncontrasting

confidence: 43%

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Dumitraşcu¹,

Martiniuc²,

Brasoveanu³

et al. 2018

chr

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“…Consequently, the incidence of PMV complications, such as stenosis and thrombosis, following pancreatic surgery is expected to increase. PMV thrombosis and stenosis have been seen in up to 18% and 51% of patients, respectively, in some series (8)(9)(10). PMV stenosis and thrombosis can lead to PV and/or mesenteric venous hypertension and associated complications, with substantial morbidity and, if left untreated, potentially death (11).…”

Section: Pancreatic Surgery With Venous Reconstruction Pancreatic Surmentioning

confidence: 99%

“…However, owing to the increasing use of more aggressive neoadjuvant and adjuvant therapies such as chemoradiation therapy and major vascular reconstruction in recent years, there is an increased risk of postoperative PMV stenosis and/or thrombus formation, depending on the type of venous reconstruction. PMV thrombosis and stenosis in up to 18% and 51% of patients, respectively, have been reported in some series (8)(9)(10). Although prophylactic anticoagulation is often considered in the postoperative setting, to our knowledge, there are no prospective data supporting its use for prevention of venous complications.…”

Section: Pmv Complications and Sequelae After Venous Reconstructionmentioning

confidence: 99%

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

et al. 2020

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Pancreatic surgery with en bloc venous resection and reconstruction is becoming increasingly common in the current era of expanding neoadjuvant oncologic therapies and advanced surgical techniques for patients with more anatomically complex tumors. However, patients who have alterations in their venous outflow are at increased risk for postoperative portomesenteric venous stenosis and/or thrombosis. Cross-sectional imaging for postoperative surveillance, including multiphase CT or MRI, is critical for recognizing portomesenteric venous complications and thus implementing early intervention and preventing complications related to portomesenteric venous hypertension. Hypertension-related complications include ascites, variceal or gastrointestinal bleeding, postprandial abdominal pain, intestinal edema, protein-losing enteropathy, malabsorptive diarrhea, and splenomegaly. Percutaneous transhepatic, transsplenic, and transjugular portomesenteric interventions, including venoplasty, stent placement, and thrombectomy or thrombolysis, are safe and effective options for restoring patency to the portomesenteric venous system. Preintervention CT or MRI and diagnostic catheter venography are important for procedural planning, while postintervention CT or MRI surveillance is critical for detecting recurrent stenosis or thrombosis, or de novo portomesenteric venous disease.

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“…In cases where a graft is needed, recent studies came to demonstrate that using an allograft significantly reduces the risk of postoperative thrombosis of the graft (26). The risk of postoperative thrombosis of the graft in cases in which synthetic grafts are used has been also demonstrated in the study conducted by Gao et al (27). In the paper published by this team in 2016, the authors included 62 patients submitted to direct reconstruction of the portal vein and seven cases submitted to reconstruction using a synthetic allograft.…”

Section: Discussionmentioning

confidence: 91%

“…In the paper published by this team in 2016, the authors included 62 patients submitted to direct reconstruction of the portal vein and seven cases submitted to reconstruction using a synthetic allograft. They demonstrated that the rate of venous thrombosis was of 16.7% among the first group and 85.7% among the second group; moreover, although it was not statistically significant, patients included in the first group reported a higher median overall survival; however, this fact was probably related to a lower extension of the disease (27).…”

Section: Discussionmentioning

confidence: 95%

Superior Mesenteric and Portal Vein Reconstruction With Cadaveric Allograft During Pancreatoduodenectomy – A Case Report and Literature Review

Bacalbaşa

Bălescu²,

Vîlcu

et al. 2020

In Vivo

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Comparison of patency rates and clinical impact of different reconstruction methods following portal/superior mesenteric vein resection during pancreatectomy

Cited by 24 publications

References 42 publications

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

One Hundred Pancreatectomies with Venous Resection for Pancreatic Adenocarcinoma

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

Superior Mesenteric and Portal Vein Reconstruction With Cadaveric Allograft During Pancreatoduodenectomy – A Case Report and Literature Review

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