Pancreatectomy with vein reconstruction: technique matters

BackgroundA variety of techniques have been described for portal vein (PV) and/or superior mesenteric vein (SMV) resection/reconstruction during a pancreatectomy.The ideal strategy remains unclear. MethodsPatients who underwent PV/SMV resection/reconstruction during a pancreatectomy from 2005 to 2014 were identified. Medical records and imaging were retrospectively reviewed for operative details and outcomes, with particular emphasis on patency. ResultsNinety patients underwent vein resection/reconstruction with one of five techniques: (i) longitudinal venorrhaphy (LV, n=17); (ii) transverse venorrhaphy (TV, n=9); (iii) primary end-to-end (n=28); (iv) patch venoplasty (PV, n=17); and (v) interposition graft (IG, n=19). With a median follow-up of 316days, thrombosis was observed in 16/90 (18%). The rate of thrombosis varied according to technique. All patients with primary end-to-end or TV remained patent. LV, PV and IG were all associated with significant rates of thrombosis (P=0.001 versus no thrombosis). Comparing thrombosed to patent, there were no differences with respect to pancreatectomy type, pre-operative knowledge of vein involvement and neoadjuvant therapy. Prophylactic aspirin was used in 69% of the total cohort (66% of patent, 81% of thrombosed) and showed no protective benefit. ConclusionsPrimary end-to-end and TV have superior patency than the alternatives after PV/SMV resection and should be the preferred techniques for short (<3cm) reconstructions.