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Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes

Langenbeck's Archives of Surgery volume 399, pages 461–471 (2014)Cite this article

Abstract

Purpose

Combined portal vein and/or superior mesenteric vein (PV/SMV) resection with pancreatic resection sometimes leads to prolonged survival for patients with pancreatic cancer. In this study, we evaluated perioperative outcomes of patients with PV/SMV reconstruction and considered indications for the use of a graft during this procedure.

Methods

We performed PV/SMV resection with pancreatic resection in 128 patients, including 14 using grafts. Complications associated with PV/SMV reconstruction and harvesting venous grafts and reconstructed PV/SMV patency during follow-up were assessed.

Results

Of the 128 patients, 5 underwent total pancreatectomy, 99 pancreaticoduodenectomy, and 24 distal pancreatectomy. In the 14 patients who underwent PV/SMV reconstruction with grafts, the grafts were harvested from the external iliac vein (EIV) in 10 patients and internal jugular vein (IJV) in the other 4. Five patients (3.9 %) had an intraoperative or postoperative acute thrombus or stenosis of reconstructed PV/SMV after direct end-to-end anastomosis. However, PV/SMV patency was excellent after reconstruction using grafts. There were no significant differences in other complications between groups with and without the use of grafts. Three patients (30 %) with EIV grafts had postoperative leg edema, and one of them required analgesics until his death because of leg pain caused by compartment syndrome, whereas no patients with IJV grafts had complications associated with sacrificing veins.

Conclusions

Depending on the length and/or position of the removed PV/SMV segment, interposed graft may be required for reconstruction in some patients, and the use of graft vein, particularly using IJV, is an appropriate procedure that is not associated with any complications.

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Affiliations

  1. Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Seiko Hirono, Manabu Kawai, Masaji Tani, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata & Hiroki Yamaue

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  1. Seiko Hirono
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  2. Manabu Kawai
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  3. Masaji Tani
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  4. Ken-ichi Okada
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  5. Motoki Miyazawa
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  6. Atsushi Shimizu
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  7. Yuji Kitahata
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  8. Hiroki Yamaue
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Correspondence to Hiroki Yamaue.

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Hirono, S., Kawai, M., Tani, M. et al. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbecks Arch Surg 399, 461–471 (2014). https://doi.org/10.1007/s00423-014-1182-x

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  • DOI: https://doi.org/10.1007/s00423-014-1182-x

Keywords

  • Portal vein reconstruction using a graft
  • Pancreatectomy
  • External iliac vein graft
  • Internal jugular vein graft
  • Portal vein thrombus