Segmental portal/superior mesenteric vein resection and reconstruction with the iliac vein after pancreatoduodenectomy

Abstract

ObjectiveThe results of segmental venous resection (VR) combined with pancreatoduodenectomy (PD) are controversial but may be promising. Few studies have described reconstruction of the portal/superior mesenteric vein (PV/SMV) with the iliac vein harvested from donation after cardiac death (DCD).MethodsFrom January 2014 to April 2016, PD combined with segmental excision of the PV/SMV (VR group) was performed in 21 patients with adenocarcinoma of the head of the pancreas (ADHP). The authors established a new technique of venous reconstruction using the iliac vein from DCD and analysed patients’ long-term survival.ResultsThe tumour dimensions and tumour staging were greater and the operation time was longer in the VR than PD group; however, no differences in the resection degree, blood loss, complications, reoperation rate, or mortality rate were found. The median survival was similar between the VR and PD groups. The long-term patency of the donor iliac vein was 90%. The degree of resection was a strong predictor of long-term survival.ConclusionSegmental PV/SMV resection combined with PD is applicable to selective patients with venous invasion by ADHP if R0 resection has probably been achieved. An iliac vein obtained by DCD provides an effective graft for venous reconstruction.

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

“…The PRISMA flow diagram for systematic review is presented in Figure 1 . Twenty-three studies comparing PD+VR and standard PD for patients with PHAC, published between May 1998 and November 2019, were considered suitable for the meta-analysis [ 8 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. On review of the data extraction, there was 100% agreement between the three reviewers.…”

Venous resection during pancreatectomy for pancreatic cancer: a systematic review

“…Data on duration of surgery were available in 11 (13,17,21,23,28,30,37,43,44,46,47) of 41 studies which demonstrated a prolonged operating time in patients with VR. The mean operating time was 491 minutes (ranging from 342 to 667) for patients undergoing pancreatectomy with VR, compared to 399 minutes (ranging from 306 to 568) for patients without VR (P<0.00001).…”

“…The mean operating time was 491 minutes (ranging from 342 to 667) for patients undergoing pancreatectomy with VR, compared to 399 minutes (ranging from 306 to 568) for patients without VR (P<0.00001). Meanwhile, data on blood loss during operation was available only in 8 studies (17,21,23,28,34,37,44,46). The average blood loss in the VR+ group was 929 mL (ranging from 343 to 1,686) and in the VR− group 581 mL (ranging from 353 to 866), indicating VR with increased blood loss (P=0.0001).…”

“…Seventeen studies (9,10,13,17,20,21,23,27,28,33,37,40,42,43,46,47,49), including 2,469 patients, reported about re-operation rates. Two hundred eighty three patients underwent re-operations, 104 in the VR+ group and 179 in the VR− group, respectively.…”

“…Nine studies (13,17,21,30,34,37,41,46,47), containing 1,445 patients in total, reported the tumor size as a prognostic variable. The average tumor dimension in the VR+ group was 35.7 mm (range, 28.2-47.9 mm), and the dimension in VR− group was 30.8 mm (range, 26.7-41 mm).…”