Pancreatectomy with vein reconstruction: technique matters

HPB (Oxford). 2015 Sep;17(9):824-31. doi: 10.1111/hpb.12463. Epub 2015 Jul 30.


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.

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Period
  • Male
  • Mesenteric Veins / surgery*
  • Middle Aged
  • Pancreatectomy / methods*
  • Pancreatic Neoplasms / blood supply
  • Pancreatic Neoplasms / surgery*
  • Plastic Surgery Procedures / methods*
  • Portal Vein / surgery*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / methods*