Spiral Vein Graft Reconstruction Technique for Venous Resection in Borderline Operable Pancreatic Cancer
Ilkka K. Kantonen, Assistant Professor, Hanna Seppanen, Arto Kokkola, Caj Haglund.
Helsinki University, Helsinki, Finland.
Objectives: We have used a novel reconstruction technique for portal or superior mesenteric vein resection in borderline operable pancreatic cancer. The postoperative outcomes from pancreatic surgery with different vascular reconstruction (VR) were analyzed.
Methods: There were 974 patients who had pancreatic surgery at the Helsinki University Hospital 2000-14. When cancer infiltration to the superior mesenteric (SMV) or portal vein (PV) was detected excision and reconstruction by either tangential, end-to-end anastomosis or a spiral graft from great saphenous vein (GSV) was performed. The GSV was excised and splitted open, side branches were ligated. It was sown around a 5-10 ml syringe. The spiral graft was anastomosed with SMV and PV. Splenic vein was anastomosed end-to-side to the graft.
Results: There were 123 (13 %) pancreatic cancer patients who had VR. Of these 108 (90 %) had pancreaticoduodenectomy, 11 (9 %) total pancreatectomy and 4 (3 %) distal resection. There were 45 (37 %) patients with spiral GSV graft reconstruction, 53 (43 %) with end-to-end anastomosis, 11 (9 %) with tangential suture or patch and 14 patients had other kind of reconstruction (including arterial). There was one in-hospital death (d 38) for surgical complications in end-to-end anastomosis group. This patient was the only one with a grade C fistula. None had grade B, and 3 (7 %) had grade A fistula postoperatively. There were no significant differences in re-operations with different kind of VR techniques.
Conclusions: This is a first series showing that patients with borderline resectable pancreatic cancer demanding a portal or superior mesenteric vein can be safely and feasibly reconstructed with a spiral graft from great saphenous vein.
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