title: Safety of portal vein resection using centrifugal pump-assisted venous bypass between the superior mesenteric vein and the umbilical vein.
abstract: OBJECTIVE
  To achieve complete resection of pancreatic cancer, portal vein resection has been performed with increasing frequency at the time of pancreaticoduodenal resection (pancreaticoduodenectomy or total pancreatectomy). In the meantime, visceral congestion and liver ischemia are of great concern during the procedure. We investigated safety of portal vein resection using a centrifugal pump-assisted bypass between the superior mesenteric vein and the umbilical vein.
  
  
  METHODS
  A retrospective comparison was performed in 49 consecutive patients who underwent pancreatoduodenal resection with or without portal vein resection using the bypass for pancreatic cancer. Twenty-two patients underwent portal vein resection using the bypass (group 1). The other 27 patients undergoing pancreatoduodenal resection without portal vein resection comprise the control group (group 2).
  
  
  RESULTS
  Total operative time was 756 +/- 159 min and 526 +/- 109 min (p<0.001) and median blood loss was 2090 mL and 1200 mL in groups 1 and 2, respectively. However, the centrifugal pump-assisted bypass allowed stable bypass flow, and neither intestinal edema nor ischemic change of the liver was observed during portal vein resection and the subsequent reconstruction. Postoperatively, the peak postoperative AST, ALT and total bilirubin levels showed no significant difference and postoperative day of starting a liquid diet was similar between the groups (9.0 +/- 5.4 vs. 9.8 +/- 3.8 days, p=0.48). In addition, the rates of morbidity (55% vs. 48%) including biliary and pancreatic leak as well as mortality (9% vs. 4%) did not significantly differ between the 2 groups.
  
  
  CONCLUSIONS
  The centrifugal pump-assisted bypass may be useful to prevent hepatic ischemia and visceral congestion during portal vein resection procedures, resulting in similar postoperative outcomes to the control after pancreaticoduodenal resection for pancreatic cancer.
authors.affiliation: Department of Gastroenterological Surgery Graduate School of Medical Sciences, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. szk@med.kobe-u.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Isao
authors.initials: I
authors.lastname: Yoshida
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Tanioka
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000368:Aged; D001243:Assisted Circulation; D001663:Bilirubin / Q000097:blood; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D014471:Umbilical Veins
chemical_list: D000637:Transaminases; D001663:Bilirubin