title: Pancreatectomy with vein reconstruction: technique matters.
abstract: BACKGROUND
  A variety of techniques have been described for portal vein (PV) and/or superior mesenteric vein (SMV) resection/reconstruction during a pancreatectomy. The ideal strategy remains unclear.
  
  
  METHODS
  Patients who underwent PV/SMV resection/reconstruction during a pancreatectomy from 2005 to 2014 were identified. Medical records and imaging were retrospectively reviewed for operative details and outcomes, with particular emphasis on patency.
  
  
  RESULTS
  Ninety patients underwent vein resection/reconstruction with one of five techniques: (i) longitudinal venorrhaphy (LV, n = 17); (ii) transverse venorrhaphy (TV, n = 9); (iii) primary end-to-end (n = 28); (iv) patch venoplasty (PV, n = 17); and (v) interposition graft (IG, n = 19). With a median follow-up of 316 days, thrombosis was observed in 16/90 (18%). The rate of thrombosis varied according to technique. All patients with primary end-to-end or TV remained patent. LV, PV and IG were all associated with significant rates of thrombosis (P = 0.001 versus no thrombosis). Comparing thrombosed to patent, there were no differences with respect to pancreatectomy type, pre-operative knowledge of vein involvement and neoadjuvant therapy. Prophylactic aspirin was used in 69% of the total cohort (66% of patent, 81% of thrombosed) and showed no protective benefit.
  
  
  CONCLUSIONS
  Primary end-to-end and TV have superior patency than the alternatives after PV/SMV resection and should be the preferred techniques for short (<3 cm) reconstructions.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Klausner
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Hwa
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*