Venous thrombosis following pancreaticoduodenectomy with venous resection

J Surg Res. 2018 Aug;228:271-280. doi: 10.1016/j.jss.2018.02.006. Epub 2018 Apr 13.

Abstract

Background: Addition of en bloc segmental venous reconstruction (VR) to pancreaticoduodenectomy (PD) for venous involvement of pancreatic tumors increases the complexity of the operation and may increase complications. The long-term mesenteric venous patency rate and oncologic outcome has not been well defined.

Methods: Our prospective database was reviewed to assess 90-day postoperative outcomes for patients who underwent PD or PD + VR (September 2004-June 2016). Two independent observers reviewed CT scans to determine long-term vein patency. In patients with pancreatic ductal adenocarcinoma, the impact of VR on 5-year overall survival was assessed using multivariate Cox proportional hazards regression. Student's t-test was used to evaluate continuous variables and the chi-square test for categorical variables.

Results: Three hundred ninety-three patients underwent PD (51 PD + VR). Patients undergoing PD + VR had longer operations (561 ± 119 versus 433 ± 89 min, P < 0.00001) and greater blood loss (768 ± 812 versus 327 ± 423 cc, P < 0.00001). There was no difference in 90-day mortality, overall postoperative complication rates, complication severity grades, reoperation, readmission, or length of stay. 26.7% experienced venous thrombosis. Most thromboses occurred in the first year after surgery, but we also observed late thrombosis in 1 patient after 89-month follow-up. Among 135 patients with pancreatic ductal adenocarcinoma, survival was significantly longer in the PD-alone group (31.3 months [95% confidence interval: 22.9-40.0] versus 17.0 [95% confidence interval: 13.0-19.1], plog-rank = 0.013).

Conclusions: PD + VR does not increase short-term morbidity, but venous thrombosis is frequent and can occur long after surgery. Survival is inferior when VR is required especially in the absence of neoadjuvant chemotherapy.

Keywords: Pancreatic ductal adenocarcinoma; Pancreaticoduodenectomy; Vein resection.

MeSH terms

  • Aged
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Blood Loss, Surgical / statistics & numerical data
  • Carcinoma, Pancreatic Ductal / mortality
  • Carcinoma, Pancreatic Ductal / surgery*
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Mesenteric Veins / surgery*
  • Middle Aged
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / methods
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Reconstructive Surgical Procedures / adverse effects*
  • Reconstructive Surgical Procedures / methods
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Patency
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / epidemiology*
  • Venous Thrombosis / etiology