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  • Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy

    Author(s)
    Chua, TC
    de Reuver, PR
    Staerkle, RF
    Neale, ML
    Arena, J
    Mittal, A
    Shanbhag, ST
    Gill, AJ
    Samra, JS
    Griffith University Author(s)
    Chua, Terence
    Year published
    2016
    Metadata
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    Abstract
    Background: Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. Methods: Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared ...
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    Background: Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. Methods: Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared between groups. Results: 110 patients underwent PD with MPV resection of which reconstruction was performed with an end-to-end technique in 92 patients (84%) and transverse closure technique in 18 patients (16%). Patients undergoing transverse closure tended to have had a shorter segment of vein resected (≤2 cm) compared to the end-to-end (83% vs. 43%; P = 0.004) with no difference in R0 rate. Short-term morbidity was similar. The median and 5-year survival was 30.0 months and 18% respectively for patients undergoing transverse closure and 28.6 months and 7% respectively for patients undergoing end-to-end reconstruction (P = 0.766). Conclusion: Without compromising the R0 rate, transverse closure to reconstruct the mesenteric-portal vein is shown to be feasible and safe in the setting when a short segment of vein resection is required during pancreatoduodenectomy. Synopsis - We describe a vein closure technique, transverse closure, which avoids the need for a graft, or re-implantation of the splenic vein when resection of the mesenteric-portal vein confluence is required during pancreatoduodenectomy.
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    Journal Title
    European Journal of Surgical Oncology
    Volume
    42
    Issue
    2
    DOI
    https://doi.org/10.1016/j.ejso.2015.08.167
    Subject
    Oncology and carcinogenesis
    Pancreatoduodenectomy
    Transverse closure
    Vascular resection
    Venous resection
    Publication URI
    http://hdl.handle.net/10072/409017
    Collection
    • Journal articles

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