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Journal of Gastrointestinal Surgery

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01-08-2014 | Original Article

Prosthetic Graft for Superior Mesenteric-Portal Vein Reconstruction in Pancreaticoduodenectomy: A Retrospective, Multicenter Study

Authors: Kai Liao, Huaizhi Wang, MD, PhD, Qilong Chen, MD, PhD, Zheng Wu, MD, PhD, Leida Zhang, MD, PhD

Published in: Journal of Gastrointestinal Surgery | Issue 8/2014

Abstract

Background

The use of prosthetic grafts for superior mesenteric-portal vein reconstruction (SMPVR) after pancreaticoduodenectomy (PD) with venous resection remains controversial. We evaluated the effectiveness and safety of using polytetrafluoroethylene (PTFE) interposition grafts for SMPVR after PD.

Methods

We identified 76 patients who underwent PD with segmental vein resection for pancreatic head and periampullary neoplasms at three centers between January 2007 and June 2012. The venous reconstruction technique depended on the length of venous involvement. Forty-two and 34 patients underwent SMPVR with primary anastomosis and SMPVR with PTFE interposition grafts, respectively. The postoperative morbidity, mortality, and patency were compared. For the patients with pancreatic ductal adenocarcinoma (n = 65), survival was compared between the SMPVR with primary anastomosis (n = 36) and SMPVR with PTFE interposition graft groups (n = 29).

Results

Patients undergoing SMPVR with PTFE grafts had larger tumor sizes (3.4 ± 0.9 cm, 2.9 ± 0.9 cm, P = 0.016), longer operative durations (492.9 ± 107.5 min, 408.8 ± 78.8 min, P < 0.001), and greater blood loss (986.8 ± 884.5 ml, 616.7 ± 485.5 ml, P = 0.040) compared to those undergoing SMPVR with primary anastomosis. However, 30-day postoperative morbidity and mortality did not differ (29.4 and 2.9 %, respectively, for PTFE grafts and 33.3 and 7.1 %, respectively, for primary anastomosis). There were no cases of graft infection. The estimated cumulative patency of SMPVR 6 and 12 months after surgery did not differ (87.9 and 83.5 % after PTFE grafts, respectively, and 94.4 and 86.4 % after primary anastomosis, respectively). For patients who underwent surgery for pancreatic ductal adenocarcinoma, there were no significant differences in the median survival time (11 vs. 12 months) or the 1-, 2-, and 3-year survival rates (35.7, 12.5, and 4.2 vs. 36.4, 17.3, and 8.7 %, respectively) for the PTFE and primary anastomosis groups.

Conclusions

PTFE grafts could provide a safe and effective option for venous reconstruction after PD in patients with segmental vein resection.

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Title: Prosthetic Graft for Superior Mesenteric-Portal Vein Reconstruction in Pancreaticoduodenectomy: A Retrospective, Multicenter Study
Authors: Kai Liao
Huaizhi Wang, MD, PhD
Qilong Chen, MD, PhD
Zheng Wu, MD, PhD
Leida Zhang, MD, PhD
Publication date: 01-08-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 8/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2549-6

At a glance: The STEP trials

Springer Medicine

Prosthetic Graft for Superior Mesenteric-Portal Vein Reconstruction in Pancreaticoduodenectomy: A Retrospective, Multicenter Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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