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Successful Venous Repair and Reconstruction for Oncologic Resections
Yana Etkin, MD, Paul J. Foley, III, MD, Grace J. Wang, MD, Guzzo J. Guzzo, MD, Robert E. Roses, MD, Douglas L. Fraker, MD, Jeffrey A. Drebin, MD, PhD, Benjamin M. Jackson, MD.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVES:
We report our institutional experience of various venous reconstruction methods during oncologic resections, especially examining the patency of venous reconstructions and the conduits used.
METHODS:
All patients undergoing venous repair or reconstruction for oncologic resections between 2008 and 2014 were identified by a retrospective search of a prospectively-maintained database at a single university hospital. Extent and manner of venous reconstruction and conduit or patch material were recorded. Need for intraoperative veno-venous bypass or cardiopulmonary bypass were also recorded. While no prescribed follow up protocol has been instituted, patency and survival data as available were analyzed.
RESULTS:
119 patients were identified during the study period. Five patients had primary ligations, without limb loss. Of the remaining 114 patients, 73 (64%) underwent primary repairs, 23 (20%) had patch repair, and 18 (16%) had bypasses. Of these, 26 (23%) were for portal vein reconstruction during Whipple, 42 (37%) were for caval repair during caval thrombectomy in the setting of renal cell cancer, and 27 (24%)were for caval repair during resection for other abdominal malignancies. (Table 1) Veno-venous bypass was used in 16 repairs and cardiopulmonary bypass in 8. Patency of all bypass grafts was 87% at one year. Occlusions were only suffered in the prosthetic grafts group. There was no limb loss or significant long term morbidity in patients with occluded grafts. Rate of infection was 0%, and there was no evidence of an increased infection rate in prosthetic or bioprosthetic conduits or patches. Perioperative mortality was 6%.
CONCLUSIONS:
The portal vein reconstruction during Whipple can be done with bovine pericardium despite contamination and prosthetic grafts can be used for most reconstructions with no infections and good patency rates. Overall, venous reconstruction for oncologic resection can be done safely with very low complication rates and good patency rates.
Table 1: Techniques of venous reconstruction| Type of Repair | Portal Vein | Vena Cava | Other Intra-abdominal | Extremity | 1 Year Patency | | Primary | 7 | 51 | 11 | 4 | 100% | | Patch | 15 | 7 | 1 | - | 100% | | Bypass | 4 | 11 | 2 | 1 | 87% |
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