Long-term results in pancreatectomy with and without venous resection: a comparison of safety and complications in spiral graft, end-to-end and tangential/patch reconstruction techniques

Tiina Vuorela, Pirkka Vikatmaa, Arto Kokkola, Harri Mustonen, Aino Salmiheimo, Annika Eurola, Pekka Aho, Caj Haglund, Ilkka Kantonen, Hanna Seppänen
Roughly 10-20% of pancreatic cancer patients are candidates for curative-intent surgical treatment. In the 2000s, many studies showed similar survival rates comparing pancreatic surgery with or without vein resection and reconstruction. We aimed to identify the best method of venous reconstruction. We performed a retrospective cohort study. We identified 1375 patients undergoing pancreatectomy between 2005 and 2018. We included patients undergoing a combined pancreatic resection and venous
more » ... struction retrospectively. When tumour infiltration to the portal/superior mesenteric vein was detected, excision and reconstruction with tangential suturing/patch, end-to-end anastomosis or a spiral graft from the great saphenous vein was performed. We then analysed 90-day and long-term survival, and outcomes across reconstruction techniques. Overall, 198 patients had venous involvement visible in preoperative scans or detected during surgery, broken down as follows: 171 (86%) a pancreaticoduodenectomy, 12 (6%) a total pancreatectomy and 15 (8%) a distal pancreatectomy. In total, 69 (35%) spiral graft reconstructions, 77 (39%) end-to-end anastomoses and 52 (26%) tangential/patch reconstructions were performed. Tumour histology revealed pancreatic adenocarcinomas in 162 (82%) patients, intraductal mucinous pancreatic neoplasia in 14 (7%), cholangiocarcinoma in five (3%), neuroendocrine neoplasia in nine (5%) and eight other diagnoses. Overall, 183 (92%) were malignant and 15 (8%) benign. Two patients died within 90 days, one in-hospital and one on postoperative day 38 due to thrombosis in the superior mesenteric vein and intestinal necrosis, a Clavien-Dindo grade 5 complication. In addition, 50 (23%) patients had Clavien-Dindo grade 3-4 complications. We detected no differences in complications comparing vein reconstruction techniques or in the long-term survival of pancreatectomy patients with or without venous reconstruction. The spiral graft technique, used when more advanced venous infiltration occurs, does not increase complications, with outcomes mirroring those accompanying shorter venous resections.
doi:10.1016/j.ejvs.2022.04.006 pmid:35462018 fatcat:7swrqtbl5jashodafxw3h65wce