title: Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection.
abstract: In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH).
  
  
  
  The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence.
  
  
  
  The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05).
  
  
  
  In PD with resection of PV-SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Gyoten
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. mizunos@clin.medic.mie-u.ac.jp.
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Motonori
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Clinical Research Support Center, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010976:Platelet Count; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000473:pathology; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery