title: Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes.
abstract: OBJECTIVE
  Combined portal vein and/or superior mesenteric vein (PV/SMV) resection with pancreatic resection sometimes leads to prolonged survival for patients with pancreatic cancer. In this study, we evaluated perioperative outcomes of patients with PV/SMV reconstruction and considered indications for the use of a graft during this procedure.
  
  
  METHODS
  We performed PV/SMV resection with pancreatic resection in 128 patients, including 14 using grafts. Complications associated with PV/SMV reconstruction and harvesting venous grafts and reconstructed PV/SMV patency during follow-up were assessed.
  
  
  RESULTS
  Of the 128 patients, 5 underwent total pancreatectomy, 99 pancreaticoduodenectomy, and 24 distal pancreatectomy. In the 14 patients who underwent PV/SMV reconstruction with grafts, the grafts were harvested from the external iliac vein (EIV) in 10 patients and internal jugular vein (IJV) in the other 4. Five patients (3.9 %) had an intraoperative or postoperative acute thrombus or stenosis of reconstructed PV/SMV after direct end-to-end anastomosis. However, PV/SMV patency was excellent after reconstruction using grafts. There were no significant differences in other complications between groups with and without the use of grafts. Three patients (30 %) with EIV grafts had postoperative leg edema, and one of them required analgesics until his death because of leg pain caused by compartment syndrome, whereas no patients with IJV grafts had complications associated with sacrificing veins.
  
  
  CONCLUSIONS
  Depending on the length and/or position of the removed PV/SMV segment, interposed graft may be required for reconstruction in some patients, and the use of graft vein, particularly using IJV, is an appropriate procedure that is not associated with any complications.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitahata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation; D007601:Jugular Veins / Q000637:transplantation; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency