Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Radiology, Oslo University Hospital, Oslo, Norway.
J Vasc Surg Venous Lymphat Disord. 2018 Jan;6(1):66-74. doi: 10.1016/j.jvsv.2017.09.003. Epub 2017 Nov 8.
Superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction during pancreatic surgery are increasingly common. Several reconstruction techniques exist. The aim of this study was to evaluate characteristics of patients and clinical outcomes for SMV/PV reconstruction using interposed cold-stored cadaveric venous allograft (AG+) or primary end-to-end anastomosis (AG-) after segmental vein resections during pancreatic surgery.
All patients undergoing pancreatic surgery with SMV/PV resection and reconstruction from 2006 to 2015 were identified. Clinical and histopathologic outcomes as well as preoperative and postoperative radiologic findings were assessed.
A total of 171 patients were identified. The study included 42 and 71 patients reconstructed with AG+ and AG-, respectively. Patients in the AG+ group had longer mean operative time (506 minutes [standard deviation, 83 minutes] for AG+ vs 420 minutes [standard deviation, 91 minutes] for AG-; P < .01) and more intraoperative bleeding (median, 1000 mL [interquartile range (IQR), 650-2200 mL] for AG+ vs 600 mL [IQR, 300-1000 mL] for AG-; P < .01). Neoadjuvant therapy was administered more frequently for patients in the AG+ group (23.8% vs 8.5%; P = .02). Patients with AG+ had a longer length of tumor-vein involvement (median, 2.4 cm [IQR, 1.6-3.0 cm] for AG+ vs 1.8 cm [IQR, 1.2-2.4 cm] for AG-; P = .01), and a higher number of patients had a tumor-vein interface >180 degrees (35.7% for AG+ vs 21.1% for AG-; P = .02). There was no difference in number of patients with major complications (42.9% for AG+ vs 36.6% for AG-; P = .51) or early failure at the reconstruction site (9.5% for AG+ vs 8.5% for AG-; P = 1). A subgroup analysis of 10 patients in the AG+ group revealed the presence of donor-specific antibodies in all patients.
The short-term outcome of SMV/PV reconstruction with interposed cold-stored cadaveric venous allografts is comparable to that of reconstruction with primary end-to-end anastomosis. Graft rejection could be a contributing factor to severe stenosis in patients reconstructed with allograft.
在胰腺手术中，肠系膜上静脉/门静脉（SMV/PV）切除和重建越来越常见。目前存在多种重建技术。本研究旨在评估在胰腺手术中进行节段性静脉切除后使用间置冷保存尸体静脉移植物（AG+）或直接端端吻合（AG-）进行 SMV/PV 重建的患者特征和临床结局。
确定了 2006 年至 2015 年间接受胰腺手术伴 SMV/PV 切除和重建的所有患者。评估了临床和组织病理学结局以及术前和术后影像学发现。
共确定了 171 例患者。该研究包括分别用 AG+和 AG-重建的 42 例和 71 例患者。AG+组的平均手术时间更长（506 分钟[标准差 83 分钟]比 AG-组的 420 分钟[标准差 91 分钟]；P<.01），术中出血量更多（中位数 1000 毫升[四分位距 650-2200 毫升]比 AG-组的 600 毫升[四分位距 300-1000 毫升]；P<.01）。AG+组更常接受新辅助治疗（23.8%比 8.5%；P=.02）。AG+组的肿瘤-静脉受累长度更长（中位数 2.4 厘米[四分位距 1.6-3.0 厘米]比 AG-组的 1.8 厘米[四分位距 1.2-2.4 厘米]；P=.01），且更多患者的肿瘤-静脉界面>180 度（AG+组为 35.7%，AG-组为 21.1%；P=.02）。两组在主要并发症发生率（AG+组为 42.9%，AG-组为 36.6%；P=.51）或重建部位早期失败（AG+组为 9.5%，AG-组为 8.5%；P=1）方面无差异。AG+组的 10 例患者的亚组分析显示，所有患者均存在供体特异性抗体。
间置冷保存尸体静脉移植物进行 SMV/PV 重建的短期结果与直接端端吻合重建相当。移植物排斥可能是移植物重建患者严重狭窄的一个因素。
