scholarly journals Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Medicine ◽  
2019 ◽  
Vol 98 (3) ◽  
pp. e14204 ◽  
Author(s):  
Xin Wang ◽  
Yunqiang Cai ◽  
Wei Zhao ◽  
Pan Gao ◽  
Yongbin Li ◽  
...  
Keyword(s):  
Superior Mesenteric Vein ◽  
Interposition Graft ◽  
Mesenteric Vein ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Vein Resection

scholarly journals Pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head with venous resection

2016 ◽  
Vol 50 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Vojko Flis ◽  
Stojan Potrc ◽  
Nina Kobilica ◽  
Arpad Ivanecz
Keyword(s):  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Vascular Resection ◽  
Synthetic Graft ◽  
En Bloc ◽  
Venous Reconstruction ◽  
Interposition Graft ◽  
Mesenteric Vein ◽  
Vein Resection

Abstract Background Recent reports have shown that patients with vascular tumour invasion who undergo concurrent vascular resection can achieve long-term survival rates equivalent to those without vascular involvement requiring pancreaticoduodenectomy alone. There is no consensus about which patients benefit from the portal-superior mesenteric vein resection and there is no consensus about the best surgical technique of vessel reconstruction (resection with or without graft reconstruction). As published series are small the aim of this study was to evaluate our experience in pancreatectomies with en bloc vascular resection and reconstruction of vessels. Methods Review of database at University Clinical Centre Maribor identified 133 patients (average age 65.4 ± 8.6 years, 69 female patients) who underwent pancreatoduodenectomy between January 2006 and August 2014. Clinical data, operative results, pathological findings and postoperative outcomes were collected prospectively and analyzed. Current literature and our experience in pancreatectomies with en bloc vascular resection and reconstruction of portal vein are reviewed. Results Twenty-two patients out of 133 (16.5%) had portal vein-superior mesenteric vein resection and portal vein reconstruction (PVR) during pancreaticoduodenectomy. In fourteen patients portal vein was reconstructed without the use of synthetic vascular graft. In these series two types of venous reconstruction were performed. When tumour involvement was limited to the superior mesenteric vein (SPV) or portal vein (PV) such that the splenic vein could be preserved, and vessels could be approximated without tension a primary end-to-end anastomosis was performed. When tumour involved the SMV-splenic vein confluence, splenic vein ligation was necessary. In the remaining eight procedures interposition graft was needed. Dacron grafts with 10 mm diameter were used. There was no infection after dacron grafting. One patient had portal vein thrombosis after surgery: it was thrombosis after primary reconstruction. There were no thromboses in patients with synthetic graft interposition. There were no significant differences in postoperative morbidity, mortality or grades of complication between groups of patients with or without a PVR. Median survival time in months was in a group with vein resection 16.13 months and in a group without vein resection 15.17 months. Five year survival in the group without vein resection was 19.5%. Comparison of survival curves showed equal hazard rates with log-rank p = 0.090. Conclusions Survival of patients with pancreatic cancer who undergo an R0 resection with reconstruction was comparable to those who have a standard pancreaticoduodenectomy with no added mortality or morbidity. Synthetic graft appeared to be an effective and safe option as an interposition graft for portomesenteric venous reconstruction after pancreaticoduodenectomy.

Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival

2017 ◽  
Vol 26 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Richard Bell ◽  
Braden Te Ao ◽  
Natasha Ironside ◽  
Adam Bartlett ◽  
John A. Windsor ◽  
...  
Keyword(s):  
Superior Mesenteric Vein ◽  
Meta Analysis ◽  
Cost Effective ◽  
Margin Status ◽  
Mesenteric Vein ◽  
Vein Resection ◽  
Effective Analysis

Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma

2015 ◽  
Vol 102 (7) ◽  
pp. 837-846 ◽  
Author(s):  
Y. Murakami ◽  
S. Satoi ◽  
F. Motoi ◽  
M. Sho ◽  
M. Kawai ◽  
...  
Keyword(s):  
Superior Mesenteric Vein ◽  
Pancreatic Head ◽  
Mesenteric Vein ◽  
Pancreatic Head Carcinoma ◽  
Vein Resection

Morbidity and mortality after portal/superior mesenteric vein resection during pancreatoduodenectomy

1999 ◽  
Vol 11 (12) ◽  
pp. A38
Author(s):  
R. C.I. van Geenen ◽  
L. T. de Wit ◽  
T. M. van Gulik ◽  
H. Obertop ◽  
D. J. Gouma
Keyword(s):  
Superior Mesenteric Vein ◽  
Morbidity And Mortality ◽  
Mesenteric Vein ◽  
Vein Resection

scholarly journals Comparison between long and short-term venous patencies after pancreatoduodenectomy or total pancreatectomy with portal/superior mesenteric vein resection stratified by reconstruction type

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240737
Author(s):  
Kai Siang Chan ◽  
Nandhini Srinivasan ◽  
Ye Xin Koh ◽  
Ek Khoon Tan ◽  
Jin Yao Teo ◽  
...  
Keyword(s):  
Superior Mesenteric Vein ◽  
Total Pancreatectomy ◽  
Primary Repair ◽  
Primary Patency ◽  
Reconstruction Method ◽  
Venous Reconstruction ◽  
Interposition Graft ◽  
Mesenteric Vein ◽  
Significant Difference ◽  
End To End

Background Venous reconstruction has been recently demonstrated to be safe for tumours with invasion into portal vein and/or superior mesenteric vein. This study aims to compare the patency between various venous reconstructions. Methods This is retrospective study of 76 patients who underwent pancreaticoduodenectomy or total pancreatectomy with venous reconstruction from 2006 to 2018. Patient demographics, tumour histopathology, morbidity, mortality and patency were studied. Kaplan-Meier estimates were performed for primary venous patency. Results Sixty-two patients underwent pancreaticoduodenectomy and 14 underwent total pancreatectomy. Forty-seven, 19 and 10 patients underwent primary repair, end-to-end anastomosis and interposition graft respectively. Major morbidity (Clavien-Dindo >grade 2) and 30-day mortality were 14/76(18.4%) and 1/76(1.3%) respectively. There were 12(15.8%) venous occlusion including 4(5.3%) acute occlusions. Overall 6-month, 1-year and 2-year primary patency was 89.1%, 92.5% and 92.3% respectively. 1-year primary patency of primary repair was superior to end-to-end anastomosis and interposition graft (primary repair 100%, end-to-end anastomosis 81.8%, interposition graft 66.7%, p = 0.045). Pairwise comparison also demonstrated superior 1-year patency of primary repair (adjusted p = 0.037). There was no significant difference between the cumulative venous patency for each venous reconstruction method: primary repair 84±6%, end-to-end anastomosis 75±11% and interposition graft 76±15% (p = 0.561). Conclusion 1-year primary venous patency of primary repair is superior to end-to-end anastomosis and interposition graft.

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