Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection

Glebova, Natalia O.; Hicks, Caitlin W.; Piazza, Kristen M.; Abularrage, Christopher J.; Cameron, Andrew M.; Schulick, Richard D.; Wolfgang, Christopher L.; Black, James H.

doi:10.1016/j.jvs.2015.01.061

Cited by 54 publications

(28 citation statements)

References 37 publications

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“…Our group has pre- viously published detail of our operative technique and postoper- ative management of these operative approaches. 29,30 Vascular re- sections with negative margins have been reported to be associ- ated with equivalent survival compared with standard pancreato- duodenectomy in patients with PDAC. 31,32 This finding underlines the importance of performing these complex operations at high- volume centers with surgeons and multidisciplinary teams experi- enced in managing advanced pancreatic disease.…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Blair

Rosati

Rezaee

et al. 2018

Surgery

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Background: The impact of neoadjuvant stereotactic body radiation therapy on postoperative complications for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma remains unclear. Limited studies have compared neoadjuvant stereotactic body radiation therapy versus conventional chemoradiation therapy. A retrospective study was performed to determine if perioperative complications were different among patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant stereotactic body radiation therapy or chemoradiation therapy. Methods: Patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma who underwent neoadjuvant chemotherapy with stereotactic body radiation therapy or chemoradiation therapy followed by pancreatectomy at the Johns Hopkins Hospital between 2008 and 2015 were included Predictive factors for severe complications (Clavien grade ≥ III) were assessed by univariate and multivariate analyses. Results: A total of 168 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma underwent neoadjuvant chemotherapy and RT followed by pancreatectomy. Sixty-one (36%) patients underwent stereotactic body radiation therapy and 107 (64%) patients received chemoradiation therapy. Compared with the chemoradiation therapy cohort, the neoadjuvant stereotactic body radiation therapy cohort was more likely to have locally advanced pancreatic ductal adenocarcinoma (62% vs 43% P = .017) and a require vascular resection (54% vs 37%, P = .027). Multiagent chemotherapy was used more commonly in the stereotactic body radiation therapy cohort (97% vs 75%, P < .001). Postoperative complications (Clavien grade ≥ III 23% vs 28%, P = .471) were similar between stereotactic body radiation therapy and chemoradiation therapy cohort. No significant difference in postoperative bleeding or infection was noted in either group. Conclusion: Compared with chemoradiation therapy, neoadjuvant stereotactic body radiation therapy appears to offer equivalent rates of perioperative complications in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma despite a greater percentage of locally advanced disease and more complex operative treatment.

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Section: Discussionmentioning

confidence: 99%

Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Blair

Rosati

Rezaee

et al. 2018

Surgery

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“…Conversely, in the present study, interposition graft reconstruction was associated with an increased risk of developing portal vein thrombosis, perhaps related to the greater technical complexity of this reconstruction. Early portal vein thrombosis might be the result of a technical failure, whereas late thrombosis has been associated with local recurrence. Furthermore, an immune‐mediated phenomenon in interposition graft reconstruction with cadaveric veins cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer

Ravikumar

Sabin

Hilal

et al. 2017

British Journal of Surgery

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“…Isolated vein involvement is not a contraindication to resection, with comparable short and long-term outcomes comparable to those of a standard resection [63]. Techniques that can be used for reconstruction of the PV or SMV are wedge resection with venoplasty, end-to-end anastomosis (Figure 3), patches or vein interposition grafts [64,65]. Direct end-to-end anastomosis of the PV system is safe, but when tension-free anastomosis cannot be guaranteed; generally, in cases requiring ≥3 cm of SMV/PV resection, venous autografting may decrease the likelihood of anastomotic stenosis [66].…”

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confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection

Abstract: Long operative times and use of prosthetic grafts for reconstruction are risk factors for postoperative portal vein thrombosis. Primary repair, patch, or vein interposition should be preferentially used for PVR in the setting of pancreatic resection.

Cited by 54 publications

References 37 publications

Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Postoperative complications after resection of borderline resectable and locally advanced pancreatic cancer: The impact of neoadjuvant chemotherapy with conventional radiation or stereotactic body radiation therapy

Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer

Pancreatic Cancer: Yesterday, Today and Tomorrow

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