Significance of the Splenic Vein and Its Branches in Pancreatoduodenectomy with Resection of the Portal Vein System

Abstract

Background/Aims: Pancreatic head carcinoma frequently invades the superior mesenteric vein (SMV) and/or portal vein (PV). We aimed to evaluate the outcome of transection of the splenic vein (SV) and inferior mesenteric vein (IMV) in pancreatoduodenectomy (PD) with SMV and/or PV resection. Methods: We retrospectively analyzed the records of 660 patients who had undergone pancreatectomy at our institution from January 2004 to October 2013, and selected 141 consecutive patients who had undergone PD with concurrent SMV/PV resection. Postoperative hypersplenism and the presence of remnant branches were evaluated. Results: The SV had been transected in 81 patients and preserved in 60. Postoperative complications and white blood cell counts were similar between the groups. The postoperative splenic volume was not significantly associated with the status of the SV or IMV on the transected SV. The platelet count was significantly lower, and the incidence of collateral veins was higher after SV transection than after SV preservation until 6 months after surgery; these variables were similar in the long term. Conclusion: SV reconstruction might be unnecessary when SV transection is required. Preservation of the IMV on the remnant SV might not prevent sinistral portal hypertension.