Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Finland.
Department of Vascular Surgery, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Finland.
Eur J Vasc Endovasc Surg. 2022 Aug-Sep;64(2-3):244-253. doi: 10.1016/j.ejvs.2022.04.006. Epub 2022 Apr 21.
Roughly 10% - 20% of pancreatic cancer patients are candidates for curative intent surgical treatment. In the 2000s, many studies showed similar survival rates comparing pancreatic surgery with or without vein resection and reconstruction. The aim was to identify the best method of venous reconstruction.
This was a retrospective cohort study. A total of 1 375 patients undergoing pancreatectomy between 2005 and 2018 were identified. Patients undergoing a combined pancreatic resection and venous reconstruction were included retrospectively. When tumour infiltration to the portal/superior mesenteric vein was detected, excision and reconstruction with tangential suturing/patch, end to end anastomosis, or a spiral graft from the great saphenous vein was performed. Next, 90 day and long term survival and outcomes across reconstruction techniques were analysed.
Overall, 198 patients had venous involvement visible in pre-operative scans or detected during surgery, broken down as follows: 171 (86%) pancreaticoduodenectomy, 12 (6%) total pancreatectomy, and 15 (8%) distal pancreatectomy. In total, 69 (35%) spiral graft reconstructions, 77 (39%) end to end anastomoses, and 52 (26%) tangential/patch reconstructions were performed. Tumour histology revealed pancreatic adenocarcinomas in 162 (82%) patients, intraductal mucinous pancreatic neoplasia in 14 (7%), cholangiocarcinoma in five (3%), neuro-endocrine neoplasia in nine (5%), and eight other diagnoses. Overall, 183 (92%) were malignant and 15 (8%) benign. Two patients died within 90 days, one in hospital and one on post-operative day 38 due to thrombosis of the superior mesenteric vein and intestinal necrosis, a Clavien-Dindo grade 5 complication. In addition, 50 (23%) patients had Clavien-Dindo grade 3 - 4 complications. No differences in complications comparing vein reconstruction techniques or in the long term survival of pancreatectomy patients with or without venous reconstruction were detected.
The spiral graft technique, used when more advanced venous infiltration occurs, does not increase complications, with outcomes mirroring those accompanying shorter venous resections.
约有 10%-20%的胰腺癌患者适合进行根治性手术治疗。在 21 世纪初，许多研究表明，在比较胰腺手术是否联合静脉切除和重建时，患者的生存率相似。本研究旨在确定静脉重建的最佳方法。
这是一项回顾性队列研究。共纳入 2005 年至 2018 年间行胰腺切除术的 1375 例患者。回顾性纳入行胰腺联合切除和静脉重建的患者。当肿瘤浸润门静脉/肠系膜上静脉时，采用切线缝合/补片、端端吻合或大隐静脉螺旋移植物进行切除和重建。然后分析不同重建技术的 90 天和长期生存及结局。
总体而言，198 例患者术前扫描或术中发现静脉受累，具体如下：胰十二指肠切除术 171 例（86%），全胰腺切除术 12 例（6%），胰体尾切除术 15 例（8%）。共行 69 例螺旋移植物重建、77 例端端吻合和 52 例切线/补片重建。肿瘤组织学显示 162 例（82%）为胰腺腺癌、14 例（7%）为导管内黏液性胰腺肿瘤、5 例（3%）为胆管癌、9 例（5%）为神经内分泌肿瘤和 8 例其他诊断。总体而言，183 例（92%）为恶性肿瘤，15 例（8%）为良性肿瘤。2 例患者在 90 天内死亡，1 例在院内，1 例在术后第 38 天因肠系膜上静脉血栓形成和肠坏死死亡，并发症为 Clavien-Dindo 分级 5 级。此外，50 例（23%）患者发生 Clavien-Dindo 分级 3-4 级并发症。未发现静脉重建技术之间或伴或不伴静脉重建的胰腺切除术患者的并发症存在差异，长期生存也无差异。
当发生更严重的静脉浸润时采用螺旋移植物技术，不会增加并发症，其结果与较短静脉切除的结果相似。
