Revascularization techniques for complete portomesenteric venous occlusion in patients undergoing pancreatic resection.

Autor:	Harrison JM; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Li AY; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Bergquist JR; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Ngongoni F; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Norton JA; Section of Surgical Oncology, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Dua MM; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Poultsides GA; Section of Surgical Oncology, Department of Surgery, Stanford University Hospital, Stanford, CA, USA., Visser BC; Section of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA, USA. Electronic address: bvisser@stanford.edu.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2024 Nov; Vol. 26 (11), pp. 1411-1420. Date of Electronic Publication: 2024 Jul 16.
DOI:	10.1016/j.hpb.2024.07.408
Abstrakt:	Introduction: Pancreatic pathologies causing portomesenteric occlusion complicate extirpative pancreatic resection due to portomesenteric hypertension and collateral venous drainage. Methods: Patients with portomesenteric occlusion undergoing pancreatectomy were identified between 2007 and 2020 at Stanford University Hospital. Demographic and clinical data, technique and perioperative factors, and post-operative outcomes were analyzed. Results: Of twenty-seven (27) patients undergoing venous revascularization during pancreatectomy, most (15) were for pancreatic neuroendocrine tumor. Occlusions occurred mostly at the portosplenic confluence (15). Median occlusion length was 4.0 cm [3.1-5.8]. Regarding revascularization strategy, mesocaval shunting was used in 11 patients, in-line venous revascularization with internal jugular conduit in three patients, traditional venous resection and reconstruction in 9 patients, and thrombectomy in two patients. Median cohort operative time and estimated blood loss were 522 min [433-638] and 1000 mL [700-2500], respectively. Median length of stay was 10 days [8-14.5] with overall readmission rate of 37%. Significant complications occurred in 44% of patients despite only one (4%) perioperative mortality. Discussion: Despite the technical complexity for managing portomesenteric occlusions, early revascularization strategies including mesocaval shunting or in-line venous revascularization are feasible and facilitate a safe pancreatic resection for surgically fit patients. (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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