PORTAL VEIN THROMBOSIS AFTER VENOUS RECONSTRUCTION DURING PANCREATECTOMY: TIMING AND RISKS
Alexandra M. Roch*, E M. Kilbane, Trang K. Nguyen, Eugene P. Ceppa, Nicholas J. Zyromski, C. Max Schmidt, Attila Nakeeb, Michael G. House
Indiana University School of Medicine, Indianapolis, IN
Background: Numerous studies have shown that portal vein resection during pancreatectomy can help achieve complete tumor clearance and long term-survival. Although the benefits of vascular resection are well documented, the risk of portal vein (PV) thrombosis after reconstruction remains unclear. This study aimed to describe the incidence and risk factors of PV thrombosis.
Methods: All patients who underwent portal vein resection (PVR) during pancreatectomy (2007-2019) were identified from a single institution prospective clinical database. Demographic and clinical data, operative and pathological findings, as well as postoperative outcomes were analyzed.
Results: Pancreatectomy with PVR was performed in 220 patients (mean age 65.1, male/female ratio 0.96). Thrombosis occurred in 36 (16.4%) patients after a median of 15.5 days [IQR 38.5, 1-786d]. PV patency rates were 92.7% and 88.7% at 1 and 3 months, respectively. The rate of PV thrombosis varied according to PV reconstruction technique: 12.8% after venorrhaphy, 13.2% end-to-end anastomosis, 22.6% autologous vein and 83.3% synthetic graft (p<0.0001). PV thrombosis was associated with an increased 30-day mortality (16.7%vs.4.9%,p=0.02), and overall complications (69.4%vs.42.9%,p=0.006). Multivariate analysis of patients with thrombosed vs. patent venous reconstruction is summarized in the attached table. Pancreatectomy type, neoadjuvant chemoradiation, pathologic vein invasion, resection margin status, and manner of perioperative anticoagulation did not influence incidence of PV thrombosis.
Conclusion: Portal vein thrombosis developed in 16% of patients who underwent pancreatectomy with PVR at a median of 15 days. PVR with interposition graft carries the highest risk for thrombosis. PV thrombosis is associated with a nearly 5-times increased risk of postoperative sepsis after pancreatectomy.
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