title: Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia. Electronic address: terence.c.chua@gmail.com.
authors.forename: T C
authors.initials: TC
authors.lastname: Chua
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: de Reuver
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors.forename: R F
authors.initials: RF
authors.lastname: Staerkle
authors.affiliation: Department of Vascular Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Neale
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Arena
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: S T
authors.initials: ST
authors.lastname: Shanbhag
authors.affiliation: Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Discipline of Surgery, University of Sydney, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, NSW, Australia. Electronic address: jas.samra@bigpond.com.
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000601:surgery; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002277:Carcinoma / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008488:Medical Illustration; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D018365:Neoplasm, Residual; D018358:Neuroendocrine Tumors / Q000601:surgery*; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate; D058106:Wound Closure Techniques / Q000009:adverse effects
keywords: Pancreatoduodenectomy; Transverse closure; Vascular resection; Venous resection