Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy

T. C. Chua, P. R. De Reuver, R. F. Staerkle, M. L. Neale, J. Arena, A. Mittal, S. T. Shanbhag, A. J. Gill, J. S. Samra*

*Corresponding author for this work

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Abstract

Background Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. Methods Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared between groups. Results 110 patients underwent PD with MPV resection of which reconstruction was performed with an end-to-end technique in 92 patients (84%) and transverse closure technique in 18 patients (16%). Patients undergoing transverse closure tended to have had a shorter segment of vein resected (≤2 cm) compared to the end-to-end (83% vs. 43%; P = 0.004) with no difference in R0 rate. Short-term morbidity was similar. The median and 5-year survival was 30.0 months and 18% respectively for patients undergoing transverse closure and 28.6 months and 7% respectively for patients undergoing end-to-end reconstruction (P = 0.766). Conclusion Without compromising the R0 rate, transverse closure to reconstruct the mesenteric-portal vein is shown to be feasible and safe in the setting when a short segment of vein resection is required during pancreatoduodenectomy. Synopsis - We describe a vein closure technique, transverse closure, which avoids the need for a graft, or re-implantation of the splenic vein when resection of the mesenteric-portal vein confluence is required during pancreatoduodenectomy.

Original languageEnglish
Pages (from-to)211-218
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume42
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

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Keywords

  • Pancreatoduodenectomy
  • Transverse closure
  • Vascular resection
  • Venous resection

Cite this

Chua, T. C., De Reuver, P. R., Staerkle, R. F., Neale, M. L., Arena, J., Mittal, A., ... Samra, J. S. (2016). Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy. European Journal of Surgical Oncology, 42(2), 211-218. https://doi.org/10.1016/j.ejso.2015.08.167