title: Pancreatoduodenectomy with venous or arterial resection: a NSQIP propensity score analysis.
abstract: Vascular resection during pancreatoduodenectomy (PD) is being performed more frequently. Our aim was to analyze the outcomes of PD with and without vascular resection in a large, multicenter cohort.
  
  
  
  Patient data were gathered from 43 institutions as part of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pancreatectomy Demonstration Project. Over a 14-month period, 1414 patients underwent PD without (82.2%) or with major venous (PD + V; 13.7%) or arterial (PD + A; 4.0%) vascular resection.
  
  
  
  Postoperative morbidity and mortality following PD + A (51.0% and 3.6%) was comparable to PD + V (46.9% and 3.6%) and PD (44.3 and 1.5%, p = 0.50 and 0.43). A propensity score matched analysis revealed that vascular resection was associated with significant increases (p ≤ 0.05) in operative time (7:37 vs 6:11), need for blood transfusion (42.2% vs 18.1%), deep venous thromboembolism (6.9% vs 0.9%), postoperative septic shock (6.9% vs 1.7%), and length of stay (12.2 vs 10 days) while overall morbidity (45.7% vs 46.6) and mortality (1.0% vs 0%) were comparable.
  
  
  
  Compared to PD alone, PD + VR was associated with increased operative time, perioperative transfusions, deep venous thrombosis, septic shock, as well as length of stay, but overall morbidity and mortality were not increased.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Joal D
authors.initials: JD
authors.lastname: Beane
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.affiliation: University of Wisconsin School of Medicine, Madison, WI, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Pitt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Zarzaur
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.affiliation: Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. Electronic address: Henry.Pitt@tuhs.temple.edu.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014680:Veins / Q000601:surgery*; D054556:Venous Thromboembolism / Q000209:etiology