Segmental portal/superior mesenteric vein resection and reconstruction with the iliac vein after pancreatoduodenectomy.
Objective The results of segmental venous resection (VR) combined with pancreatoduodenectomy (PD) are controversial but may be promising. Few studies have described reconstruction of the portal/superior mesenteric vein (PV/SMV) with the iliac vein harvested from donation after cardiac death (DCD). Methods From January 2014 to April 2016, PD combined with segmental excision of the PV/SMV (VR group) was performed in 21 patients with adenocarcinoma of the head of the pancreas (ADHP). The authors established a new technique of venous reconstruction using the iliac vein from DCD and analysed patients' long-term survival. Results The tumour dimensions and tumour staging were greater and the operation time was longer in the VR than PD group; however, no differences in the resection degree, blood loss, complications, reoperation rate, or mortality rate were found. The median survival was similar between the VR and PD groups. The long-term patency of the donor iliac vein was 90%. The degree of resection was a strong predictor of long-term survival. Conclusion Segmental PV/SMV resection combined with PD is applicable to selective patients with venous invasion by ADHP if R0 resection has probably been achieved. An iliac vein obtained by DCD provides an effective graft for venous reconstruction.
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Xin
X
Zhao
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Li-Xin
LX
Li
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Hua
H
Fan
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Jian-Tao
JT
Kou
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Xian-Liang
XL
Li
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Ren
R
Lang
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Qiang
Q
He
D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004386:Duodenum / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation*; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D010179:Pancreas / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis
Pancreatoduodenectomy; donation after cardiac death; iliac vein; venous reconstruction; venous resection