Open AccessSignificance of Simultaneous Splenic Artery Resection in Left‐Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
Author(s) -
Gyoten Kazuyuki,
Mizuno Shugo,
Nagata Motonori,
Ogura Toru,
Usui Masanobu,
Isaji Shuji
Publication year - 2017
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-017-3916-8
Subject(s) - medicine , pancreaticoduodenectomy , gastroenterology , splenic vein , splenic artery , abdominal surgery , odds ratio , superior mesenteric vein , varices , group b , portal hypertension , surgery , portal vein , pancreas , cirrhosis
Background In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left‐sided portal hypertension (LPH). Methods The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A ( n = 16), SV was divided and SA was preserved in Group B ( n = 58), and both SV and SA were divided in Group C ( n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence. Results The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively ( p < 0.001), and variceal bleeding occurred only in Group B ( n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05). Conclusion In PD with resection of PV–SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.