Abstract
The use of interposition grafts for portal-superior mesenteric vein (PV-SMV) reconstruction during pancreatoduodenectomy (PD) with venous resection (VR) for localized periampullary tumors is a controversial topic. The present meta-analysis aimed to evaluate the perioperative and long-term outcomes in patients who received interposition grafts for PV-SMV reconstruction after PD with VR. The correlative databases were systematically searched to identify relevant trials comparing vein grafts versus no vein grafts during PD with VR. 14 studies including 257 patients with vein grafts and 570 patients without vein grafts were extracted. The meta-analysis indicated no difference in perioperative morbidity, mortality, or thrombosis between the two groups, but the vein graft group was associated with a significantly increased venous thrombosis rate (≥ 6 months) (odds ratio [OR] = 2.75; 95% confidence interval [CI], 1.32–5.73; P = .007). The autologous vein group subgroup analysis also revealed a significantly increased vein thrombosis rate (OR = 3.13; 95% CI, 1.45–6.76; P = .004) between the two groups. Meanwhile, the prosthetic vein group subgroup analysis indicated no difference. Additionally, the oncological value of vein grafts during PD for pancreatic cancer survival was analyzed and revealed no difference in 1-year, 3-year, or 5-year survival between the two groups. Using interposition grafts for PV-SMV reconstruction is safe and effective, and has perioperative outcomes and long-term survival rates compared to those with no vein grafts during PD with VR. However, the lower long-term vein patency rate in patients with vein grafts indicate that interposition grafts may be more likely to lose function.
Highlights
Pancreatoduodenectomy (PD) provides the only possibility for a cure or for the long-term survival of patients with pancreatic and periampullary neoplasms [1]
The present meta-analysis for the first time assesses the available data on the outcomes of patients who underwent prosthetic vein (PV)-SMV reconstruction with vein grafts during
The findings revealed that the duration of the operation, resected venous lengths, and clamping time were longer and blood loss was greater in patients with vein grafts undergoing portal-superior mesenteric vein (PV-SMV) reconstruction during PD than in patients without vein grafts, perioperative mortality, overall morbidity rates, and perioperative thrombosis were comparable between the groups
Summary
Pancreatoduodenectomy (PD) provides the only possibility for a cure or for the long-term survival of patients with pancreatic and periampullary neoplasms [1]. The techniques used for PV-SMV reconstruction are classified into four main types—primary end-to-end anastomosis, venorrhaphy, patch venoplasty, and graft interposition—and remain a controversial issue [9,10,11]. Several studies have determined that PV-SMV resection can be performed with primary end-to-end anastomosis or venorrhaphy reconstruction, avoiding a vein graft [15, 16]. When primary end-to-end anastomosis has a risk of stenosis or over-tension of the PV-SMV reconstruction, an interposed graft is necessary [5]. Because of the risk of developing a postoperative or long-term PV-SMV thrombus leading to bowel ischemia, sepsis, or death [22,23,24], it remains controversial which patients are indicated for use of an interposed graft for PV-SMV reconstruction when undergoing PD with venous resection to promote postoperative and long-term PVSMV thrombus
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