PMID- 29128301 OWN - NLM STAT- MEDLINE DCOM- 20180730 LR - 20221207 IS - 2213-3348 (Electronic) VI - 6 IP - 1 DP - 2018 Jan TI - Portal vein reconstruction using primary anastomosis or venous interposition allograft in pancreatic surgery. PG - 66-74 LID - S2213-333X(17)30433-X [pii] LID - 10.1016/j.jvsv.2017.09.003 [doi] AB - OBJECTIVE: Superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction during pancreatic surgery are increasingly common. Several reconstruction techniques exist. The aim of this study was to evaluate characteristics of patients and clinical outcomes for SMV/PV reconstruction using interposed cold-stored cadaveric venous allograft (AG+) or primary end-to-end anastomosis (AG-) after segmental vein resections during pancreatic surgery. METHODS: All patients undergoing pancreatic surgery with SMV/PV resection and reconstruction from 2006 to 2015 were identified. Clinical and histopathologic outcomes as well as preoperative and postoperative radiologic findings were assessed. RESULTS: A total of 171 patients were identified. The study included 42 and 71 patients reconstructed with AG+ and AG-, respectively. Patients in the AG+ group had longer mean operative time (506 minutes [standard deviation, 83 minutes] for AG+ vs 420 minutes [standard deviation, 91 minutes] for AG-; P < .01) and more intraoperative bleeding (median, 1000 mL [interquartile range (IQR), 650-2200 mL] for AG+ vs 600 mL [IQR, 300-1000 mL] for AG-; P < .01). Neoadjuvant therapy was administered more frequently for patients in the AG+ group (23.8% vs 8.5%; P = .02). Patients with AG+ had a longer length of tumor-vein involvement (median, 2.4 cm [IQR, 1.6-3.0 cm] for AG+ vs 1.8 cm [IQR, 1.2-2.4 cm] for AG-; P = .01), and a higher number of patients had a tumor-vein interface >180 degrees (35.7% for AG+ vs 21.1% for AG-; P = .02). There was no difference in number of patients with major complications (42.9% for AG+ vs 36.6% for AG-; P = .51) or early failure at the reconstruction site (9.5% for AG+ vs 8.5% for AG-; P = 1). A subgroup analysis of 10 patients in the AG+ group revealed the presence of donor-specific antibodies in all patients. CONCLUSIONS: The short-term outcome of SMV/PV reconstruction with interposed cold-stored cadaveric venous allografts is comparable to that of reconstruction with primary end-to-end anastomosis. Graft rejection could be a contributing factor to severe stenosis in patients reconstructed with allograft. CI - Copyright (c) 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Kleive, Dyre AU - Kleive D AD - Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: dyrkle@ous-hf.no. FAU - Berstad, Audun Elnaes AU - Berstad AE AD - Department of Radiology, Oslo University Hospital, Oslo, Norway. FAU - Sahakyan, Mushegh A AU - Sahakyan MA AD - Institute of Clinical Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway. FAU - Verbeke, Caroline S AU - Verbeke CS AD - Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Oslo University Hospital, Oslo, Norway. FAU - Naper, Christian AU - Naper C AD - Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway. FAU - Haugvik, Sven Petter AU - Haugvik SP AD - Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. FAU - Gladhaug, Ivar P AU - Gladhaug IP AD - Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. FAU - Line, Pal-Dag AU - Line PD AD - Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. FAU - Labori, Knut Jorgen AU - Labori KJ AD - Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. LA - eng PT - Journal Article DEP - 20171108 PL - United States TA - J Vasc Surg Venous Lymphat Disord JT - Journal of vascular surgery. Venous and lymphatic disorders JID - 101607771 RN - 0 (Isoantibodies) SB - IM MH - Aged MH - Allografts MH - Anastomosis, Surgical MH - Blood Loss, Surgical MH - Carcinoma, Pancreatic Ductal/diagnostic imaging/pathology/*surgery MH - Computed Tomography Angiography MH - Female MH - Graft Occlusion, Vascular/etiology/physiopathology MH - Graft Rejection/etiology MH - Humans MH - Iliac Vein/diagnostic imaging/immunology/physiopathology/*transplantation MH - Isoantibodies/blood MH - Male MH - Mesenteric Veins/diagnostic imaging/pathology/physiopathology/*surgery MH - Middle Aged MH - Operative Time MH - Pancreatectomy/adverse effects/*methods MH - Pancreatic Neoplasms/diagnostic imaging/pathology/*surgery MH - Phlebography/methods MH - Portal Vein/diagnostic imaging/pathology/physiopathology/*surgery MH - Plastic Surgery Procedures/adverse effects/*methods MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Ultrasonography MH - Vascular Patency MH - Vascular Surgical Procedures/adverse effects/*methods EDAT- 2017/11/13 06:00 MHDA- 2018/07/31 06:00 CRDT- 2017/11/13 06:00 PHST- 2017/04/25 00:00 [received] PHST- 2017/09/07 00:00 [accepted] PHST- 2017/11/13 06:00 [pubmed] PHST- 2018/07/31 06:00 [medline] PHST- 2017/11/13 06:00 [entrez] AID - S2213-333X(17)30433-X [pii] AID - 10.1016/j.jvsv.2017.09.003 [doi] PST - ppublish SO - J Vasc Surg Venous Lymphat Disord. 2018 Jan;6(1):66-74. doi: 10.1016/j.jvsv.2017.09.003. Epub 2017 Nov 8.