Pancreaticoduodenectomy with venous resection and reconstruction: current surgical techniques and associated postoperative imaging findings
Introduction of effective neoadjuvant therapy for pancreas cancer has resulted in complex and aggressive operations involving vasculature resection. This results in complicated postoperative CT appearance of vasculature, which in addition to high rate of recurrence makes interpretation of imaging difficult. The aim of this study was to identify patterns of postoperative appearance of portal vein-superior mesenteric vein complex (PV-SMV).
A retrospective study was conducted on patients undergoing pancreaticoduodenectomy with PV-SMV resection and reconstruction (PVR) between 2004 and 2014. Clinicopathological data were collected from a prospectively maintained database. Postoperative CT scans were reviewed to identify patterns of venous and perivenous features.
The mean age, of 70 patients included in the study, was 63.0 ± 12.2 years and 37 (52.9%) were males. The median time between surgery and postoperative scan was 10 days (IQR 7–25). Tangential resection with PVR via primary closure or use of a patch was performed in 37 (52.9%) patients while the rest underwent segmental resection with PVR via end-to-end anastomosis or use of a graft. Postoperative patterns of PV-SMV included concentric narrowing (N = 40, 57.1%), eccentric narrowing (N = 19, 27.1%) or partial venous thrombosis (N = 7, 10.0%). Perivenous features included perivenous fluid collection and induration (N = 57, 81.4%) and mass-like soft tissue thickening (N = 13, 18.6%). Long-term follow-up was available on 44 (62.9%) patients of which 28 (63.6%) demonstrated no recurrence of disease.
This is a novel study that identifies and categorizes postoperative features of PV-SMV after PVR. These features overlap with those of disease recurrence and their better understanding can results in an accurate interpretation of postoperative imaging.
KeywordsPancreaticoduodenectomy Portal vein resection and reconstruction PV-SMV complex Vascular structure Recurrence of pancreas cancer
Compliance with ethical standards
No funding was required to perform this study.
Conflict of interest
Author Ammar A. Javed declares that he has no conflict of interest. Author Karen Bleich declares that he has no conflict of interest. Author Fabio Bagante declares that he has no conflict of interest. Author Jin He declares that he has no conflict of interest. Author Matthew J. Weiss declares that he has no conflict of interest. Author Christopher L. Wolfgang declares that he has no conflict of interest. Author Elliot K. Fishman declares that he has no conflict of interest.
This was a retrospective study that was approved by the Institutional Review Board for Human Research and complied with all Health Insurance Portability and Accountability Act regulations.
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