Portomesenteric Venous Thrombosis after Pancreatic Cancer Surgery with Venous Resection and Reconstruction: Timing, Incidence, and Risk Factors.

Autor:	Ishida H; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.; Department of Hepatobiliary and Pancreatic Surgery, Institute of Science Tokyo, Tokyo, Japan., Watanabe S; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.; Department of Hepatobiliary and Pancreatic Surgery, Institute of Science Tokyo, Tokyo, Japan., Rodriguez Franco S; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Franklin O; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.; Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden., Stoop TF; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Kirsch MJ; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Schulick RD; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Del Chiaro M; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Dec 16. Date of Electronic Publication: 2024 Dec 16.
DOI:	10.1097/SLA.0000000000006605
Abstrakt:	Objective: To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR). Summary Background Data: Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated. Methods: This study included pancreatic cancer patients undergoing any type of pancreatic resection with PVR at the University of Colorado Hospital between January 2012 and June 2023. The study period was divided based on the implementation of local standardization of PVR techniques in August 2018. PVT was classified as early or late (≤ or >30 d postoperatively). Risk factors for late PVT were assessed with Cox regression models. Results: Among 152 patients, 3.3% (n=5) developed early PVT. Its incidence decreased from 12% (n=3/25) to 1.6% (n=2/127) after technical standardization (P=0.03). Of 130 patients with available postoperative imaging, 21.5% (n=28) developed late PVT at a median of 7.4 months from surgery. Late PVT was frequently diagnosed with local recurrence (75%) and was associated with shorter recurrence-free survival (median 9.0 vs. 16.3 mo, P=0.014). Multivariable analysis showed that neoadjuvant radiotherapy (hazard ratio [HR], 2.19; 95% CI, 1.02-4.67) and local recurrence (HR, 5.21; 95% CI, 2.18-12.4) were associated with an increased risk of late PVT. Conclusions: Early PVT after pancreatectomy with PVR is rare. Late PVT is associated with neoadjuvant radiotherapy and local recurrence. These findings may inform risk assessment in pancreatic cancer patients undergoing PVR. Competing Interests: Financial disclosure/conflicts of interest: Marco Del Chiaro has received an industry grant (Haemonetics, Inc) to conduct a multicenter study. Marco Del Chiaro is a co-principal investigator of an international multicenter study sponsored by Boston Scientific. Richard D. Schulick is a co-inventor of a patent licensed to DynamiCure (managed by the University of Colorado) outside the submitted work. No other disclosures were reported from the other authors. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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