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Vein resection during pancreaticoduodenectomy for pancreatic adenocarcinoma: Patency rates and outcomes associated with thrombosis
Author(s) -
Snyder Rebecca A.,
Prakash Laura R.,
NoguerasGonzalez Graciela M.,
Kim Michael P.,
Aloia Thomas A.,
Vauthey JeanNicolas,
Lee Jeffrey E.,
Fleming Jason B.,
Katz Matthew H.G.,
Tzeng ChingWei D.
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25067
Subject(s) - medicine , pancreaticoduodenectomy , adenocarcinoma , surgery , anastomosis , thrombosis , retrospective cohort study , portal vein , resection , vein , portal vein thrombosis , deep vein , superior mesenteric vein , cancer
Background and Objectives Venous patency rates after pancreaticoduodenectomy (PD) with portal vein (PV) resection are not well established, and the oncologic impact of portal vein thrombosis (PVT) is unknown. The primary aim of this study was to determine rates and predictors of PVT after PD with PV resection for pancreatic adenocarcinoma (PDAC). Methods A retrospective cohort study was performed on PDAC patients treated with preoperative therapy and PD with PV resection at a high‐volume institution (2008‐15). Primary outcomes were early and late PVT (≤ or >90 days of surgery). Secondary outcomes included major complications and OS. Results Patients undergoing vein resection ( N = 120) included 41.7% ( N = 50) primary repair or patch venoplasty, 29.2% ( N = 35) primary anastomosis, and 29.2% ( N = 35) interposition graft. Thirty‐four (28.3%) patients developed PVT (early 7.5% [ N = 9]; late 20.8% [ N = 25]). Late PVT was often detected concurrently with local recurrence (76.0%; N = 19). There was no association of PVT with vascular resection extent or complications ( P > 0.05). On multivariable analysis, PVT was associated with worse OS (HR 2.2 [95% CI 1.34‐3.5], P < 0.001). Conclusions Overall postoperative patency rates following PV resection PDAC were high. PVT is associated with worse OS, which appears less likely related to technical issues, but rather representative of disease biology.