Contemporary perioperative outcomes for portal vein resection and reconstruction following pancreaticoduodenectomy for malignancy

Abstract

Background: Portal vein resection and reconstruction (PVRR) can be technically challenging during pancreatectomy for cancer, but is sometimes necessary with disease involvement of the mesenteric vessels. This study examined if PVRR negatively impacted perioperative outcomes in a modern patient cohort. Methods: All patients who underwent pancreaticoduodenectomy (PD) or total pancreatectomy (TP) from 2010-2014 for invasive malignancy at our center were retrospectively reviewed. Clinicopathologic variables were compared and univariate logistic regression was used to compare outcomes between patients who underwent PVRR and those who did not. Results: During the study period, 309 patients underwent PD or TP for resection of malignancy, with 78 (25.2%) patients requiring PVRR. Primary repair of the defect was the most common method of PVRR (62.8%), followed by end-to-end repair (23.1%), side-to-side repair (5.1%), and autologous vein patch (5.1%). Nonautologous patch repair was used in only 2.6% of cases, with no cases of synthetic graft use. The PVRR group had increased operative time (495±153 vs. 437±130 minutes, p=0.001), decreased formation of pancreatic fistula (10.3% vs. 21.6%, p=0.029), and decreased deep surgical site infection (9.0% vs. 22.1%, p=0.011). There is no difference between groups for all other examined complications, including PV thrombosis (2.6% vs. 1.3%, p=0.603) in short-term follow-up. Conclusions: Most PVRR can be performed primarily, and synthetic material can be avoided entirely with modern techniques. Despite increased operative time, perioperative complications appear to be either unchanged or reduced in PVRR patients. This may be due to increased utilization of neoadjuvant therapy in this group.Tabled 1Comparison of outcomes in patients who underwent PVRR and no PVRR during PD/TP for invasive malignancy.PVRR (N=78)No PV Resection (N=231)P ValueOperative Time (mins)495 ± 153437 ± 1300.001Hospital LOS (days)9.3 ± 3.910.4 ± 6.80.177All Complications36 (46.2%)129 (55.8%)0.150Superficial SSI9 (11.5%)22 (9.5%)0.663Deep SSI7 (9.0%)51 (22.1%)0.011Pancreatic Fistula (grade B or C)8 (10.3%)50 (21.6%)0.029Required Blood Transfusion13 (16.7%)29 (12.6%)0.347PV Thrombus2 (2.6%)3 (1.3%)0.603Reoperation2 (2.6%)9 (3.9%)0.736 Open table in a new tab