Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review

Labori, Knut Jørgen; Kleive, Dyre; Khan, Ammar Hameed; Farnes, Ingvild; Fosby, Bjarte; Line, Pål–Dag

doi:10.1016/j.hpb.2020.11.008

Cited by 21 publications

(23 citation statements)

References 56 publications

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“…The same study emphasized that using the right external iliac vein as an interposition graft is safe and effective since direct end-to-end anastomosis and graft interposition in patients with PC showed no differences in short-term outcomes. Recently, Labori et al reported a systematic review of the use of four graft types (autologous veins, synthetic grafts, cadaveric allografts, and parietal peritoneum/falciform ligament) for PV/SMV resection (14). Even though the rest three types seem to have a lower risk of early graft thrombosis (<30 days) (2.5-6.7%) than that of synthetic grafts (7.5%), thrombosis occurs with all types of grafts.…”

Section: Long-segment Pv/smv Encasementmentioning

confidence: 99%

Extent of venous resection during pancreatectomy—finding the balance of technical possibility and feasibility

Oba¹,

Kato²,

Inoue³

et al. 2021

J Gastrointest Oncol

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The improvement of effective multidrug agents has allowed more patients to undergo resection for pancreatic cancer (PC). In the conversion cases of initially unresectable PC after induction chemotherapy, pancreatic surgeons often encounter challenging vein resections cases such as those of long-segment portal vein (PV)/superior mesenteric vein (SMV) encasement or occlusion of the distal (caudal) SMV. Given the lack of consensus for the optimal approach for major vein resections and reconstructions in these situations, this review summarizes the literature on this topic and provides the best currently available approaches for challenging vein reconstruction cases. For long-segment PV/SMV encasement, tips for direct end-to-end anastomosis without grafts and the splenic vein (SpV) reconstruction to prevent left-side portal hypertension will be introduced. For distal SMV encasement, several bypass techniques to deal with collateralizations will be introduced. Even though some high-volume PC centers are obtaining favorable outcomes for challenging vein resection cases, existing evidence on this topic is limited. It is essential to organize the well-designed international multicenter studies for the small population of challenging vein resection cases. With the emergence of effective chemotherapies, the number of PC patients who can undergo curative resection is increasing. Achieving more successful vessel resection and reconstruction in the treatment of PC is a common goal that pancreatic surgeons should focus on together.

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Section: Long-segment Pv/smv Encasementmentioning

confidence: 99%

Extent of venous resection during pancreatectomy—finding the balance of technical possibility and feasibility

Oba¹,

Kato²,

Inoue³

et al. 2021

J Gastrointest Oncol

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“…In 2020, Labori et al [ 32 ] published a systematic review on the optimal graft type for SMV and PV in pancreatic surgery, including papers published between January 2000 and March 2020 (34 studies with 603 patients). Four graft types were identified (autologous vein, autologous parietal peritoneum/falciform ligament, allogeneic cadaveric vein/artery, synthetic grafts).…”

Section: Venous Resectionsmentioning

confidence: 99%

“…Although graft thrombosis can occur in all graft types (early incidence is 2.5–7.5%, and overall incidence is 6.2–22.2%). It should be added that the association of PTFE grafts with increased mortality was not shown in this meta-analysis [ 32 ]. In order to reduce a rate of infectious complications associated with PTFE use, various methods, such as administration of perioperative antibiotics, graft immersion in antibiotic solution, avoidance of enteric and biliary spillage, placement of an omental wrap, and use of antibiotic irrigant, were reported in the literature [ 13 , 32 ].…”

Section: Venous Resectionsmentioning

confidence: 99%

“…It should be added that the association of PTFE grafts with increased mortality was not shown in this meta-analysis [ 32 ]. In order to reduce a rate of infectious complications associated with PTFE use, various methods, such as administration of perioperative antibiotics, graft immersion in antibiotic solution, avoidance of enteric and biliary spillage, placement of an omental wrap, and use of antibiotic irrigant, were reported in the literature [ 13 , 32 ]. This study showed that generally most surgeons preferred a segmental resection with primary anastomosis or a partial venous excision with direct closure due to the higher risk of complications following the use of an interposition graft [ 32 ].…”

Section: Venous Resectionsmentioning

confidence: 99%

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Vascular Resection in Pancreatectomy—Is It Safe and Useful for Patients with Advanced Pancreatic Cancer?

Jabłońska

Król

Mrowiec

2022

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with poor prognosis and increased incidence. Surgical resection R0 remains the most important treatment to prolong survival in PDAC patients. In borderline and locally advanced cancer, vascular resection and reconstruction during pancreatectomy enables achieving R0 resection. This study is a comprehensive review of the literature regarding the role of venous and arterial resection with vascular reconstruction in the treatment of pancreatic cancer. The literature review is focused on the use of venous and arterial resection with immediate vascular reconstruction in pancreaticoduodenectomy. Different types of venous and arterial resections are widely described. Different methods of vascular reconstructions, from primary vessel closure, through end-to-end vascular anastomosis, to interposition grafts with use autologous veins (internal jugular vein, saphenous vein, superficial femoral vein, external or internal iliac veins, inferior mesenteric vein, and left renal vein or gonadal vein), autologous substitute grafts constructed from various parts of parietal peritoneum including falciform ligament, cryopreserved and synthetic allografts. The most attention was given to the most common venous reconstructions, such as end-to-end anastomosis and interposition graft with the use of an autologous vein. Moreover, we presented mortality and morbidity rates as well as vascular patency and survival following pancreatectomy combined with vascular resection reported in cited articles.

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“…A range of materials, synthetic or biological, has been used as venous substitutes. Tubular graft options include synthetic grafts (such as polytetrafluoroethylene—PTFE), autologous veins (such as left renal, saphenous, iliac, and internal jugular veins), cadaveric veins cryopreserved, and bovine pericardium 8–14 . Main concerns with the use of these sources include the risk of graft infection (mainly in synthetic grafts) and the need for additional incisions or visceral dissection to harvest autologous veins.…”

Section: Introductionmentioning

confidence: 99%

Falciform ligament tubular graft for mesenteric‐portal vein reconstruction during pancreaticoduodenectomy

Balzan

Gava

Rieger

et al. 2021

Journal of Surgical Oncology

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Background Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing surgical mortality. However, vascular reconstruction after segmental venous resection is challenging. The parietal peritoneum has emerged as a venous substitute but few reports include its use as a tubular graft. We report a retrospective series of portal vein reconstruction using a falciform ligament tubular graft during pancreaticoduodenectomy. Material and Methods Technical aspects and short‐term morbidity and mortality after pancreaticoduodenectomy with falciform ligament tubular graft interposition were analyzed. Results Among 21 patients who used parietal peritoneum for venous substitution between 2015 and 2019, eight underwent pancreaticoduodenectomy with venous resection and reconstruction using interposition of falciform ligament tubular graft. The mean duration of surgery and clamping time were 350 and 27 min, respectively. No perioperative blood transfusion was required. All the grafts were patent the day after surgery. No complication related to venous obstruction was detected during the hospital stay. Two patients had postoperative pancreatic fistula. No further intervention was needed. The 90‐day mortality was null. Conclusions The use of interposition of falciform ligament tubular graft for portal venous reconstruction during pancreaticoduodenectomy seems to be a reliable, inexpensive, and safe procedure.

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Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review

Cited by 21 publications

References 56 publications

Extent of venous resection during pancreatectomy—finding the balance of technical possibility and feasibility

Extent of venous resection during pancreatectomy—finding the balance of technical possibility and feasibility

Vascular Resection in Pancreatectomy—Is It Safe and Useful for Patients with Advanced Pancreatic Cancer?

Falciform ligament tubular graft for mesenteric‐portal vein reconstruction during pancreaticoduodenectomy

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