Vascular Reconstruction During Major Oncologic Pancreatic Resections

There is growing evidence that major vascular reconstruction performed during pancreaticoduodenectomy for malignancy may increase local resectability without increasing morbidity or mortality. The purpose of this study was to evaluate our experience with vascular reconstructions during major pancreatic resections. We performed an IRB approved review of patients with planned and unplanned vascular surgery involvement during major pancreatic resections over an 8-year period. We analyzed patient demographics, operative techniques, reconstruction patency, and early and late morbidity and mortality. Forty-four patients were included in the study. Eighteen (41%) cases were unplanned intraoperative consults, and 7 cases only involved vascular assistance with dissection without reconstruction. Average age of the patients was 64, median operative blood loss was 1.5 liters, and mean operative time was 7.5 hours. Of the 37 patients who underwent vascular reconstruction, 31 (84%) involved portal or superior mesenteric vein, 5 involved the superior mesenteric artery, 3 involved hepatic artery and one involved aortic repair. The majority of reconstructions were either primary repair (29%) or superficial femoral vein graft (32%). Sixty six percent of patients had patent vascular reconstructions on last follow up (mean f/u, 50 weeks). Perioperative mortality was 4%. Median survival for all patients was 37.6 months. Patients with adenocarcinoma (Fig) had a significantly decreased survival compared to other pathologies (16 vs 43.6 months; P = .015), although still higher than mean historical survival rates of patients with unresectable pancreatic adenocarcinoma (3-9 months). Postoperative complications related to vascular procedure occurred in 7 (16%) patients. Preoperatively planned vascular involvement showed a trend to improved short-term mortality (11% vs 0%; P = .08). Vascular reconstruction during major pancreatic resections provides good patency with acceptable vascular-related morbidity, and can be considered as an option to increase local resectability and extend survival. Preoperative vascular planning should be considered.