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01-04-2014 | Original Article

Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes

Authors: Seiko Hirono, Manabu Kawai, Masaji Tani, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Hiroki Yamaue

Published in: Langenbeck's Archives of Surgery | Issue 4/2014

Abstract

Purpose

Combined portal vein and/or superior mesenteric vein (PV/SMV) resection with pancreatic resection sometimes leads to prolonged survival for patients with pancreatic cancer. In this study, we evaluated perioperative outcomes of patients with PV/SMV reconstruction and considered indications for the use of a graft during this procedure.

Methods

We performed PV/SMV resection with pancreatic resection in 128 patients, including 14 using grafts. Complications associated with PV/SMV reconstruction and harvesting venous grafts and reconstructed PV/SMV patency during follow-up were assessed.

Results

Of the 128 patients, 5 underwent total pancreatectomy, 99 pancreaticoduodenectomy, and 24 distal pancreatectomy. In the 14 patients who underwent PV/SMV reconstruction with grafts, the grafts were harvested from the external iliac vein (EIV) in 10 patients and internal jugular vein (IJV) in the other 4. Five patients (3.9 %) had an intraoperative or postoperative acute thrombus or stenosis of reconstructed PV/SMV after direct end-to-end anastomosis. However, PV/SMV patency was excellent after reconstruction using grafts. There were no significant differences in other complications between groups with and without the use of grafts. Three patients (30 %) with EIV grafts had postoperative leg edema, and one of them required analgesics until his death because of leg pain caused by compartment syndrome, whereas no patients with IJV grafts had complications associated with sacrificing veins.

Conclusions

Depending on the length and/or position of the removed PV/SMV segment, interposed graft may be required for reconstruction in some patients, and the use of graft vein, particularly using IJV, is an appropriate procedure that is not associated with any complications.

Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR et al (1996) Rationale for en bloc vein resection in the treatment in pancreatic adenocarcinoma adherent to the superior-mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 223:154–162PubMedCentralPubMedCrossRef

Harrison LE, Klimstra DS, Brennan MF (1996) Isolated portal vein involvement in pancreatic adenocarcinoma: a contraindication for resection? Ann Surg 224:342–347PubMedCentralPubMedCrossRef

Ishikawa O, Ohigashi H, Imaoka S, Furukawa H, Sasaki Y, Fujita M et al (1992) Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 215:231–236PubMedCentralPubMedCrossRef

Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK et al (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long term survival in 136 patients. Ann Surg 247:300–309PubMedCrossRef

Ramacciato G, Mercantini P, Petrucciani N, Giaccaglia V, Nigri G, Ravaioli M et al (2009) Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 16:817–825PubMedCrossRef

Kaneoka Y, Yamaguchi A, Isogai M (2009) Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery 145:417–425PubMedCrossRef

Okada K, Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A et al (2013) Surgical strategy for patients with pancreatic body/tail carcinoma: who should undergo distal pancreatectomy with en-bloc celiac axis resection? Surgery 153:365–372PubMedCrossRef

Fujisaki S, Tomita R, Fukuzawa M (2001) Utility of mobilization of the right colon and the root of the mesentery for avoiding vein grafting during reconstruction of the portal vein. J Am Coll Surg 193:576–578PubMedCrossRef

Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM et al (2010) Prosthetic graft reconstruction after portal vein resection in pancreticoduodenectomy: a multicentric analysis. J Am Coll Surg 211:316–324PubMedCrossRef

10.

Stauffer JA, Dougherty MK, Kim GP, Nguyen JH (2009) Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg 96:247–252PubMedCrossRef

11.

Miyazaki M, Itoh H, Kaiho T, Ambiru S, Togawa A, Sasada K et al (1995) Portal vein reconstruction at the hepatic hilus using a left renal vein graft. J Am Coll Surg 180:497–498PubMed

12.

Suzuki T, Yoshidome H, Kimura F, Shimizu H, Ohtsuka M, Kato A et al (2006) Renal function is well maintained after use of left renal vein graft for vascular reconstruction in hepatobiliary-pancreatic surgery. J Am Coll Surg 202:87–92PubMedCrossRef

13.

Ohwada S, Hamada K, Kawate S, Sunose Y, Tomizawa N, Yamada T et al (2007) Left renal vein graft for vascular reconstruction in abdominal malignancy. World J Surg 31:1215–1220PubMedCrossRef

14.

Sano T, Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T (2008) Hepatobiliary resection with inferior vena cava resection and reconstruction using an autologous patch graft for intrahepatic cholangiocarcinoma. Langenbecks Arch Surg 393:599–603PubMedCrossRef

15.

Hwang S, Ha TY, Jung DH, Park JI, Lee SG (2007) Portal vein interposition using homologous iliac vein graft during extensive resection for hilar bile duct cancer. J Gastrointest Surg 11:888–892PubMedCrossRef

16.

Fleming JB, Barnett CC, Clagett GP (2005) Superficial femoral vein as a conduit for portal vein reconstruction during pancreaticoduodenectomy. Arch Surg 140:698–701PubMedCrossRef

17.

Al-Haddad M, Martin JK, Nguyen J, Pungpapong S, Raimondo M, Woodward T et al (2007) Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg 11:1168–1174PubMedCrossRef

18.

Sakamoto Y, Yamamoto J, Saiura A, Koga R, Kokudo N, Kosuge T et al (2004) Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts. Langenbecks Arch Surg 389:110–113PubMedCrossRef

19.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki JR et al (2005) International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

20.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the Internal Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768PubMedCrossRef

21.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRef

22.

Martin RC II, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA (2009) Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg 144:154–159PubMedCrossRef

23.

Wang C, Wu H, Xiong J, Zhou F, Zhou F, Tao J, Liu T et al (2008) Pancreaticoduodenectomy with vascular resection for local advanced pancreatic head cancer: a single center retrospective study. J Gastrointest Surg 12:2183–2190PubMedCrossRef

24.

Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF et al (2007) Prognostic factors in noncirrhotic patients with splanchnic vein thrombosis. Am J Gastroenterol 102:2464–2470PubMedCrossRef

25.

Turnes J, Garcia-Pagán JC, González M, Aracil C, Calleja JL, Ripoll C et al (2008) Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 6:1412–1417PubMedCrossRef

26.

Condat B, Pessione F, Helene DM, Hillaire S, Valla D (2000) Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470PubMedCrossRef

27.

Fortner JG (1985) Technique of regional subtotal and total pancreatectomy. Am J Surg 150:593–600PubMedCrossRef

28.

Cusack JC, Fuhrman GM, Lee JE, Evans DB (1994) Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 168:352–354PubMedCrossRef

29.

Strasberg SM, Bhalla S, Sanchez LA, Linehan DC (2011) Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure: comparison with collateral vein pattern in cases of sinistral portal hypertension. J Gastrointest Surg 15:2070–2079PubMedCrossRef

30.

Ferreira N, Oussoultzoglou E, Fuchehuber P, Ntourakis D, Narita M, Rather M et al (2011) Splenic vein- inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection. Arch Surg 146:1375–1381PubMedCrossRef

Title: Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes
Authors: Seiko Hirono
Manabu Kawai
Masaji Tani
Ken-ichi Okada
Motoki Miyazawa
Atsushi Shimizu
Yuji Kitahata
Hiroki Yamaue
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1182-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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