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Vein resection during pancreaticoduodenectomy for pancreatic adenocarcinoma: Patency rates and outcomes associated with thrombosis

Background and Objectives Venous patency rates after pancreaticoduodenectomy (PD) with portal vein (PV) resection are not well established, and the oncologic impact of portal vein thrombosis (PVT) is unknown. The primary aim of this study was to determine rates and predictors of PVT after PD with PV...

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Published in:Journal of surgical oncology 2018-06, Vol.117 (8), p.1648-1654
Main Authors: Snyder, Rebecca A., Prakash, Laura R., Nogueras‐Gonzalez, Graciela M., Kim, Michael P., Aloia, Thomas A., Vauthey, Jean‐Nicolas, Lee, Jeffrey E., Fleming, Jason B., Katz, Matthew H.G., Tzeng, Ching‐Wei D.
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Language:English
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Summary:Background and Objectives Venous patency rates after pancreaticoduodenectomy (PD) with portal vein (PV) resection are not well established, and the oncologic impact of portal vein thrombosis (PVT) is unknown. The primary aim of this study was to determine rates and predictors of PVT after PD with PV resection for pancreatic adenocarcinoma (PDAC). Methods A retrospective cohort study was performed on PDAC patients treated with preoperative therapy and PD with PV resection at a high‐volume institution (2008‐15). Primary outcomes were early and late PVT (≤ or >90 days of surgery). Secondary outcomes included major complications and OS. Results Patients undergoing vein resection (N = 120) included 41.7% (N = 50) primary repair or patch venoplasty, 29.2% (N = 35) primary anastomosis, and 29.2% (N = 35) interposition graft. Thirty‐four (28.3%) patients developed PVT (early 7.5% [N = 9]; late 20.8% [N = 25]). Late PVT was often detected concurrently with local recurrence (76.0%; N = 19). There was no association of PVT with vascular resection extent or complications (P > 0.05). On multivariable analysis, PVT was associated with worse OS (HR 2.2 [95% CI 1.34‐3.5], P 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.25067