J Korean Surg Soc.  2013 Jun;84(6):346-352. 10.4174/jkss.2013.84.6.346.

Reconstruction of portal vein and superior mesenteric vein after extensive resection for pancreatic cancer

• Kim SM
• Min SK
• Park D
• Min SI
• Jang JY
• Kim SW
• Ha J
• Kim SJ

• KMID: 1505184
• DOI: http://doi.org/10.4174/jkss.2013.84.6.346

Abstract

PURPOSE
Tumor invasion to the portal vein (PV) or superior mesenteric vein (SMV) can be encountered during the surgery for pancreatic cancer. Venous reconstruction is required, but the optimal surgical methods and conduits remain in controversies.
METHODS
From January 2007 to July 2012, 16 venous reconstructions were performed during surgery for pancreatic cancer in 14 patients. We analyzed the methods, conduits, graft patency, and patient survival.
RESULTS
The involved veins were 14 SMVs and 2 PVs. The operative methods included resection and end-to-end anastomosis in 7 patients, wedge resection with venoplasty in 2 patients, bovine patch repair in 3 patients, and interposition graft with bovine patch in 1 patient. In one patient with a failed interposition graft with great saphenous vein (GSV), the SMV was reconstructed with a prosthetic interposition graft, which was revised with a spiral graft of GSV. Vascular morbidity occurred in 4 cases; occlusion of an interposition graft with GSV or polytetrafluoroethylene, segmental thrombosis and stenosis of the SMV after end-to-end anastomosis. Patency was maintained in patients with bovine patch angioplasty and spiral vein grafts. With mean follow-up of 9.8 months, the 6- and 12-month death-censored graft survival rates were both 81.3%.
CONCLUSION
Many of the involved vein segments were repaired primarily. When tension-free anastomosis is impossible, the spiral grafts with GSV or bovine patch grafts are good options to overcome the size mismatch between autologous vein graft and portomesenteric veins. Further follow-up of these patients is needed to demonstrate long-term patency.

Keyword

Portal vein; Superior mesenteric vein; Reconstruction; Pancreaticoduodenectomy

MeSH Terms

Angioplasty
Constriction, Pathologic
Follow-Up Studies
Graft Survival
Humans
Mesenteric Veins
Pancreatic Neoplasms
Pancreaticoduodenectomy
Polytetrafluoroethylene
Portal Vein
Saphenous Vein
Thrombosis
Transplants
Veins
Polytetrafluoroethylene

Figure

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  Fig. 1 The superior mesenteric vein (SMV) and portal vein (PV) reconstruction with bovine patch angioplasty.

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  Fig. 2 The superior mesenteric vein (SMV) reconstruction with interposition graft with bovine patch. PV, portal vein.

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  Fig. 3 Schematic illustrations of superior mesenteric vein (SMV) reconstruction with a spiral graft with a great saphenous vein. SMA, superior mesenteric artery; PV, portal vein.

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