Chance for surgical treatment of pancreatic cancer and prolonged survival is determined by hospital of initial diagnosis: A nationwide analysis

Abstract

struction (VR) were analyzed. Patients & methods: 974 patients had pancreatic surgery at the Helsinki University Hospital 2000-14. When infiltration to the superior mesenteric (SMV) or portal vein (PV) was detected, resection and reconstruction by tangential, end-to-end anastomosis or a spiral graft from great saphenous vein (GSV) was performed. The GSV was excised, splitted open, and sown around a 5-10ml syringe. The spiral graft was anastomosed with SMV and PV. Splenic vein was anastomosed end-to-side to the graft. Results: There were 123 (13 %) pancreatic cancer patients who had VR. Of these 108 (90 %) had pancreaticoduodenectomy, 11 (9 %) total pancreatectomy and 4 (3 %) distal resection. There were 45 (37 %) patients with spiral GSV graft reconstruction, 53 (43 %) with end-to-end anastomosis, 11 (9 %) with tangential suture or patch and 14 patients had other kind of reconstruction (including arterial). There was one in-hospital death (d 38) for surgical complications in end-to-end anastomosis group. This patient was the only one with a grade C fistula. None had grade B, and 3 (7 %) had grade A fistula postoperatively. There were no significant differences in reoperations with different kind of VR techniques. Conclusion: This is a first series showing that patients with borderline resectable pancreatic cancer demanding a portal or superior mesenteric vein can be safely and feasibly reconstructed with a spiral graft from great saphenous vein.