Portal Vein Reconstruction Using Cryopreserved Veins in Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma

Abstract

Introduction: For advanced pancreatic head carcinoma, removal and reconstruction of the portal vein and/or the superior mesenteric vein are sometimes necessary to achieve R0 resection. Our institute has Tissue-Bank stocking the cryopreserved venous allografts donated based on the voluntary wish after the cardiac death. We have utilized these grafts to various surgeries with combined vascular resection. Methods: We retrospectively reviewed medical records of the 23 cases undergoing pancreatoduodenectomy with the combined resection of the portal venous systems and reconstructed it using the venous grafts for advanced pancreatic carcinoma between January 2002 and December 2019. Results: There were 12 male and 11 female, aged 73 (31-81), (median and range, same applies hereafter). Operative time was 749 (610-1148) min, estimated blood loss was 1305 (690-4350) gram. The type of portal vein resection consisted of 13 cases of circumferential segmental resection, 10 cases of wedged resection. Median postoperative hospital stay was 30 (18-105) days. There was no surgical complication greater than Clavien-Dindo IIIb. Five cases of postoperative occlusion of the allografts were observed. Graft patency rate in six months after the surgery was 75.0% and no occlusion later than 6 months were detected. Overall survival rate in one, three, and five years were 71.9%, 36.0%, 30.0% respectively. Conclusions: Reconstruction of portal vein using cryopreserved venous allografts is safe and its therapeutic effects is feasible for the pancreatoduodenectomy for advanced pancreatic carcinoma. Our techniques will be shown with a short videoclip.