title: Short-term but not long-term loss of patency of venous reconstruction during pancreatic resection is associated with decreased survival.
abstract: BACKGROUND
  Pancreatic surgery with vascular reconstruction is increasingly performed to offer the benefits of surgical resection to patients with locally advanced disease. The short- and long-term patency rates and the clinical significance of thrombosis of such reconstructions are unknown.
  
  
  METHODS
  We reviewed pancreatectomies requiring venous reconstruction from 1994 to 2011. We sought to identify predictors of acute (within 30 days) and late thrombosis. We compared survival of patients with thrombosis to patients with patent reconstructions.
  
  
  RESULTS
  Of 203 pancreatectomies requiring venous reconstruction, acute thrombosis occurred in nine (4.4 %) cases and was associated with increased perioperative mortality (22.2 versus 4.6 %, p = 0.023). Even when nonfatal, acute thrombosis was associated with decreased median survival (7.1 versus 15.9 months, p = 0.011) and increased hazard of death (hazard ratio 8.6, confidence interval 3.7-19.9, p < 0.001). A late loss of patency was seen in 31.2 % of cases at a median of 9.5 months. Later loss of patency was not associated with decreased median survival or increased hazard of death.
  
  
  CONCLUSIONS
  Acute thrombosis of the portal venous reconstructions after pancreatectomy is associated with increased perioperative mortality and, even when nonfatal, is associated with decreased survival. Late loss of patency occurs in one-third of patients but does not affect survival.
authors.affiliation: Department of Surgery, Columbia University Medical Center, 8th Floor, 161 Fort Washington Avenue, New York, NY, 10032, USA, irminagawlas@gmail.com.
authors.forename: Irmina
authors.initials: I
authors.lastname: Gawlas
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: Megan
authors.initials: M
authors.lastname: Winner
authors.forename: Joseph
authors.initials: J
authors.lastname: DiNorcia
authors.forename: Yanghee
authors.initials: Y
authors.lastname: Woo
authors.forename: James L
authors.initials: JL
authors.lastname: Lee
authors.forename: Beth A
authors.initials: BA
authors.lastname: Schrope
authors.forename: John A
authors.initials: JA
authors.lastname: Chabot
authors.forename: John D
authors.initials: JD
authors.lastname: Allendorf
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000209:etiology* / Q000503:physiopathology; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D059035:Perioperative Period; D011169:Portal Vein / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology