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Benign Portal Vein Stenosis After Pancreaticoduodenectomy

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Abstract

Background

The long-term patency of the portal vein (PV) in patients who survive after pancreaticoduodenectomy (PD) remains unclear. The aim of the present study was to investigate the clinical features and risk factors for benign PV stenosis after PD.

Methods

We retrospectively analyzed the patients who underwent PD from September 2002 and December 2015 at our institution without intraoperative radiation therapy or concomitant PV resection. The postoperative computed tomography of each patient was evaluated, and PV stenosis was defined as the shortest diameter of the PV being <3 mm. The patients with PV stenosis due to local recurrence were excluded.

Results

Of the 458 patients, PV stenosis occurred in 57 (12.4%), including benign PV stenosis in 28 (6.1%) and PV stenosis due to local recurrence in 29 (6.3%). Of the 28 patients with benign PV stenosis, 7 (25%) developed symptoms related to portal hypertension, namely recurrent gastrointestinal bleeding in 5 and refractory ascites in 2. Six patients were treated with percutaneous transhepatic PV stent placement, and all of their symptoms improved. A multivariate analysis found that a postoperative pancreatic fistula was an independent risk factor for benign PV stenosis after PD (odds ratio, 4.36; p = 0.005).

Conclusions

Postoperative pancreatic fistula was a significant risk factor for benign PV stenosis after PD. Stent placement for benign PV stenosis was effective for the patients with symptoms due to portal hypertension.

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References

  1. Woodrum DA, Bjarnason H, Andrews JC (2009) Portal vein venoplasty and stent placement in the nontransplant population. J Vasc Interv Radiol 20:593–599

    Article  PubMed  Google Scholar 

  2. Kang MJ, Jang JY, Chang YR et al (2015) Portal vein patency after pancreatoduodenectomy for periampullary cancer. Br J Surg 102:77–84

    Article  CAS  PubMed  Google Scholar 

  3. Hiyoshi M, Fujii Y, Kondo K et al (2015) Stent placement for portal vein stenosis after pancreaticoduodenectomy. World J Surg 39:2315–2322. https://doi.org/10.1007/s00268-015-3094-5

    Article  PubMed  Google Scholar 

  4. Ota S, Suzuki S, Mitsuoka H et al (2005) Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 12:88–92

    Article  PubMed  Google Scholar 

  5. Tsuruga Y, Kamachi H, Wakayama K et al (2013) Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer. World J Gastroenterol 19:2569–2573

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mizuno T, Ebata T, Yokoyama Y et al (2015) Percutaneous transhepatic portal vein stenting for malignant portal vein stenosis secondary to recurrent perihilar biliary cancer. J Hepatobiliary Pancreat Sci 22:740–745

    Article  PubMed  Google Scholar 

  7. Kim KR, Ko GY, Sung KB et al (2011) Percutaneous transhepatic stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. AJR Am J Roentgenol 196:W446–W450

    Article  PubMed  Google Scholar 

  8. Shimizu Y, Yasui K, Fuwa N et al (2005) Late complication in patients undergoing pancreatic resection with intraoperative radiation therapy: gastrointestinal bleeding with occlusion of the portal system. J Gastroenterol Hepatol 20:1235–1240

    Article  PubMed  Google Scholar 

  9. Fujii T, Nakao A, Yamada S et al (2015) Vein resections > 3 cm during pancreatectomy are associated with poor 1-year patency rates. Surgery 157:708–715

    Article  PubMed  Google Scholar 

  10. Leach SD, Lee JE, Charnsangavej C et al (1998) Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg 85:611–617

    Article  CAS  Google Scholar 

  11. Hoffer EK, Krohmer S, Gemery J et al (2009) Endovascular recanalization of symptomatic portomesenteric venous obstruction after pancreaticoduodenectomy and radiation. J Vasc Interv Radiol 20:1633–1637

    Article  PubMed  Google Scholar 

  12. Mitsunaga S, Kinoshita T, Kawashima M et al (2006) Extrahepatic portal vein occlusion without recurrence after pancreaticoduodenectomy and intraoperative radiation therapy. Int J Radiat Oncol Biol Phys 64:730–735

    Article  PubMed  Google Scholar 

  13. Yeo CJ, Sohn TA, Cameron JL et al (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227:821–831

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ziegler KM, Nakeeb A, Pitt HA et al (2010) Pancreatic surgery: evolution at a high-volume center. Surgery 148:702–709 (discussion 709–710)

    Article  PubMed  Google Scholar 

  15. Uesaka K, Boku N, Fukutomi A et al (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388:248–257

    Article  CAS  Google Scholar 

  16. Sugiura T, Uesaka K, Ohmagari N et al (2012) Risk factor of surgical site infection after pancreaticoduodenectomy. World J Surg 36:2888–2894. https://doi.org/10.1007/s00268-012-1742-6

    Article  PubMed  Google Scholar 

  17. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591

    Article  Google Scholar 

  18. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  Google Scholar 

  19. Yamashita Y, Ryo H, Takasaki K (2004) Clinical study of transient portal vein stenosis induced after pancreatic head resection. Surg Today 34:925–931

    Article  PubMed  Google Scholar 

  20. Kawano Y, Mizuta K, Sugawara Y et al (2009) Diagnosis and treatment of pediatric patients with late-onset portal vein stenosis after living donor liver transplantation. Transpl Int 22:1151–1158

    Article  CAS  PubMed  Google Scholar 

  21. Shan H, Xiao XS, Huang MS et al (2005) Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis. World J Gastroenterol 11:3315–3318

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gaujoux S, Cortes A, Couvelard A et al (2010) Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery 148:15–23

    Article  PubMed  Google Scholar 

  23. Ohgi K, Sugiura T, Yamamoto Y et al (2016) Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery 160:725–730

    Article  PubMed  Google Scholar 

  24. Yamamoto Y, Sakamoto Y, Nara S et al (2011) A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 35:2747–2755. https://doi.org/10.1007/s00268-011-1253-x

    Article  PubMed  Google Scholar 

  25. Herzog T, Belyaev O, Bakowski P et al (2013) The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube. Am J Surg 206:578–585

    Article  PubMed  Google Scholar 

  26. Robert B, Yzet T, Regimbeau JM (2013) Radiologic drainage of post-operative collections and abscesses. J Visc Surg 150:S11–S18

    Article  CAS  PubMed  Google Scholar 

  27. Buell JF, Funaki B, Cronin DC et al (2002) Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 236:658–666

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhou ZQ, Lee JH, Song KB et al (2014) Clinical usefulness of portal venous stent in hepatobiliary pancreatic cancers. ANZ J Surg 84:346–352

    Article  PubMed  Google Scholar 

  29. Stein M, Link DP (1999) Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 10:363–371

    Article  CAS  PubMed  Google Scholar 

  30. Funaki B, Rosenblum JD, Leef JA et al (2000) Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: long-term results. Radiology 215:147–151

    Article  CAS  PubMed  Google Scholar 

  31. Kim BS, Kim TK, Jung DJ et al (2003) Vascular complications after living related liver transplantation: evaluation with gadolinium-enhanced three-dimensional MR angiography. AJR Am J Roentgenol 181:467–474

    Article  PubMed  Google Scholar 

  32. Wei BJ, Zhai RY, Wang JF et al (2009) Percutaneous portal venoplasty and stenting for anastomotic stenosis after liver transplantation. World J Gastroenterol 15:1880–1885

    Article  PubMed  PubMed Central  Google Scholar 

  33. Geleto G, Getnet W, Tewelde T (2016) Mean normal portal vein diameter using sonography among clients coming to radiology department of Jimma University Hospital, Southwest Ethiopia. Ethio J Health Sci 26:237–242

    Article  Google Scholar 

  34. Luntsi G, Sani M, Zira JD et al (2016) Sonographic assessment of the portal vein diameter in apparently healthy adults in a Northern Nigerian population. Afr Health Sci 16:1163–1168

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Katsuhisa Ohgi, Teiichi Sugiura, Yusuke Yamamoto, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida & Katsuhiko Uesaka

  2. Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki

Authors
  1. Katsuhisa Ohgi
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  2. Teiichi Sugiura
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  3. Yusuke Yamamoto
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  4. Yukiyasu Okamura
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  5. Takaaki Ito
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  6. Ryo Ashida
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  7. Takeshi Aramaki
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  8. Katsuhiko Uesaka
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Correspondence to Teiichi Sugiura.

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The authors have no funding or conflicts of interest to disclose.

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Informed consent was obtained from all individual participants included in the present study.

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The present study was approved by the institutional review board of the Shizuoka Cancer Center.

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Ohgi, K., Sugiura, T., Yamamoto, Y. et al. Benign Portal Vein Stenosis After Pancreaticoduodenectomy. World J Surg 43, 2623–2630 (2019). https://doi.org/10.1007/s00268-019-05070-3

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  • DOI: https://doi.org/10.1007/s00268-019-05070-3

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