Techniques for splenic vein reconstruction after pancreaticoduodenectomy with portal vein resection for pancreatic cancer

Yoshihiro Ono, Masayuki Tanaka, Kiyoshi Matsueda, Makiko Hiratsuka, Yu Takahashi, Yoshihiro Mise, Yosuke Inoue, Takafumi Sato, Hiromichi Ito, Akio Saiura

Research output: Contribution to journalArticle

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Abstract

Background: Pancreaticoduodenectomy (PD) with splenic vein (SV) ligation may result in sinistral portal hypertension (SPH). The aim of this study was to compare the outcomes of various types of SV reconstruction to prevent SPH and to define the optimal reconstruction method. Methods: This study included patients who underwent PD with SV resection and reconstruction for pancreatic cancer between December 2013 and June 2017. The patency of various types of SV anastomosis and SPH was evaluated by follow up computed tomography. Results: The type of SV reconstruction was divided into two groups: (i) end-to-side anastomosis (n = 10), in which the SV was anastomosed with either the left renal vein (LRV; n = 8) or portal vein (n = 2); and (ii) end-to-end anastomosis (n = 20), in which the SV was anastomosed with another smaller vein or graft. The patency rate for Group 1 was 90% (9/10), compared with 45% (9/20) for Group 2 (P = 0.024). Half the patients in whom the SV anastomosis was occluded (6/12) developed gastrointestinal varices, whereas only 11% of patients with a patent SV anastomosis (2/9) had varices (P = 0.034). Conclusion: SV-LRV reconstruction is widely applicable, effectively reduces the risk of SPH, and should be considered for the case of extended PD.

Original languageEnglish
Pages (from-to)1288-1294
Number of pages7
JournalHPB
Volume21
Issue number10
DOIs
Publication statusPublished - 2019 Oct

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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  • Cite this

    Ono, Y., Tanaka, M., Matsueda, K., Hiratsuka, M., Takahashi, Y., Mise, Y., Inoue, Y., Sato, T., Ito, H., & Saiura, A. (2019). Techniques for splenic vein reconstruction after pancreaticoduodenectomy with portal vein resection for pancreatic cancer. HPB, 21(10), 1288-1294. https://doi.org/10.1016/j.hpb.2019.01.017