Graft choice in pancreatectomy with vascular resection: equivalent safety in selected patients.

Autor:	Hoffman D; Department of Surgery, University of California, San Francisco, CA, United States., Ganjouei AA; Department of Surgery, University of California, San Francisco, CA, United States., Hernandez FR; Department of Surgery, University of California, San Francisco, CA, United States., Ifuku K; Department of Surgery, University of California, San Francisco, CA, United States., Miller P; Department of Surgery, University of California, San Francisco, CA, United States., Glencer A; Department of Surgery, University of California, San Francisco, CA, United States., Corvera C; Department of Surgery, University of California, San Francisco, CA, United States; Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, United States., Kirkwood K; Department of Surgery, University of California, San Francisco, CA, United States; Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, United States., Alseidi A; Department of Surgery, University of California, San Francisco, CA, United States; Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, United States., Adam M; Department of Surgery, University of California, San Francisco, CA, United States; Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, United States., Maker A; Department of Surgery, University of California, San Francisco, CA, United States., Hirose K; Department of Surgery, University of California, San Francisco, CA, United States; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States., Hirose R; Department of Surgery, University of California, San Francisco, CA, United States; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States; Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, CA, United States., Nakakura EK; Department of Surgery, University of California, San Francisco, CA, United States; Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, United States; UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States. Electronic address: Eric.Nakakura@ucsf.edu.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Nov; Vol. 28 (11), pp. 1799-1804. Date of Electronic Publication: 2024 Aug 22.
DOI:	10.1016/j.gassur.2024.08.016
Abstrakt:	Background: Pancreatic cancer is the third leading cause of cancer-related death in the United States, with surgical resection being the only option for long-term survival. The ability to manage vascular involvement has expanded the pool of patients who are able to undergo resection with curative intent. However, not all vascular involvements can be detected preoperatively. This study aimed to investigate the patterns of vascular resection and methods of repair or reconstruction METHODS: This was a single-center retrospective review of adult patients undergoing pancreatectomy with vascular involvement at a tertiary care referral hospital between 2010 and 2022. The primary endpoint was graft thrombosis within 90 days. Results: A total of 147 patients were included in the study. Of note, 21.8% of patients were not suspected of having vascular involvement preoperatively. Moreover, 68.0% of patients required vascular reconstruction, whereas the remaining 32.0% of patients underwent repair (either primary repair or patch angioplasty). Most patients who underwent reconstruction underwent primary end-to-end anastomosis (63.0%), with 19 patients requiring autologous interposition grafts and 16 patients requiring CryoVein interposition grafts. Univariate analysis found no clinical or technical predictors of early or 90-day thrombosis, including graft choice. In addition, 30- and 90-day mortalities occurred in 1 and 7 patients, respectively. Conclusion: Pancreatectomy with vascular resection can be performed with low mortality in carefully selected patients. Unsuspected vascular involvement is relatively common (1 in 5). If autologous graft is not readily available, CryoVein is a safe alternative with similar perioperative outcomes. Competing Interests: Declaration of competing interest The authors declare no competing interests. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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