Feasibility of mesentericoportal vein reconstruction by autologous falciform ligament during pancreaticoduodenectomy-cohort study

BackgroundMesentericoportal vein (MPV) resection in pancreatic ductal adenocarcinoma (PDAC) surgery has become a common procedure. A few studies had described the use of falciform ligament (FL) for MPV reconstruction and received encouraging preliminary effects.AimsThis study was designed to explore the feasibility and efficacy of this technique compared with others.MethodsPatients who underwent pancreaticoduodenectomy (PD) with MPV resection for PDAC from 2009 to 2018 were enrolled. Medical records were retrospectively reviewed, MPV reconstructions using FL were distinguished and compared with other techniques.Results146 patients underwent MPV reconstruction, and 13 received FL venoplasty. Other reconstruction techniques included primary end-to-end anastomosis (primary, n=30), lateral venorrhaphy (LV, n=19), polytetrafluoroethylene conduit interposition (PTFE, n=24), iliac artery (IA) allografts interposition (n=47), and portal vein (PV) allografts interposition (n=13). FL group holds the advantages of shortest operation time (p=0.023), lowest blood loss (p=0.109), and shortest postoperative hospital stay (p=0.125). The grouped patency rates of FL, primary, LV, PTFE, IA, and PV were 100%, 90%, 68%, 54%, 68%, and 85% respectively. Comparison displayed that FL had the highest patency rate (p=0.008) and lowest antiplatelet/anticoagulation proportion (p=0.000). Complications and long-term survival were similar among different techniques. The median survival time of patent group (24.0 months, 95% CI: 22.0-26.0) was much longer than that of the thrombosed (17.0 months, 95% CI: 13.7-20.3), though without significant difference (P=0.148).ConclusionsPD with MPV resection and reconstruction by FL is safe, feasible, and efficacious, it might provide a potential benefit for patients.

Automated summary

This study compared different techniques for MPV reconstruction in PDAC patients, with the FL group showing advantages in operation time, blood loss, postoperative hospital stay, and patency rate. Complications and long-term survival were similar among different techniques.