Postoperative results, pathologic outcome, and long-term patency rate of autologous vein reconstruction of the mesentericoportal axis after pancreatectomy.

purposeIn advanced pancreatic cancer (PC), en-bloc vein resection and reconstruction (VR) is a curative option in oncologic pancreatectomy. However, few data about long-term patency rates after autologous venous reconstruction are available. We aimed to analyze whether early postoperative morbidity is increased by additional VR. Furthermore, pathologic outcomes and long-term patency rates after applying autologous vein material are examined.

methodsData on patients who underwent surgical resection for suspicious malignancy were collected prospectively. Early postoperative complications, as well as the circumferential resection margins were analyzed retrospectively. Patients with VR (VR+) were compared with patients without vein resection (VR-). Vein reconstruction was always performed by autologous vein replacement, followed by a 6-month application of Enoxaparin. Patency rates of the mesenteric vessels in long-term follow-up exams were determined by contrast-enhanced computed tomography (CT) every 3 months.

resultsTwo hundred nineteen pancreatic resections for suspicious malignancy were performed. In 82 patients, VR occurred (37.4%). No significant differences between VR+ and VR- were observed concerning 30-day mortality and postoperative morbidity. R0 rate did not differ between the two groups. By applying autologous vein material, the average patency rate was 90%.

conclusionIn terms of tumor free resection margins, equal oncologic results can be achieved by additional vein resection. Because the patency rate is high in follow-up, and early postoperative complication rates are not increased in patients with VR+, vein resection and reconstruction should be performed if oncologically necessary. The application of autologous vein reconstruction followed by a 6-month enoxaparin treatment seems to yield favorable technical results.