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• W3204285311 abstract "Improvements in chemoradiotherapy have rendered more complex pancreatic cancer involving the portomesenteric venous axis amenable to surgical resection. Portal vein reconstruction (PVR) has become an essential component of the operative approach. For defects of >50% of the portal vein circumference, segmental replacement will be required. Various conduits have been proposed; however, the optimal repair medium remains unknown. We have presented the midterm results of the largest series to date using an interposition cryopreserved cadaveric descending thoracic aortic homograft (CDTA) for PVR. Patient health information was recorded retrospectively from a prospectively maintained database. The data were summarized using standard statistical techniques. Fourteen patients, six men and eight women, had undergone PVR with CDTA from 2014 to 2020. Their average age was 62.6 ± 7.3 years. All the patients had had a primary diagnosis of pancreatic cancer (adenocarcinoma in 13 [93%]; neuroendocrine tumor in 1 [7%]). Most patients (n = 12; 86%) had received neoadjuvant therapy. None of the patients had had a compromised autologous conduit (great saphenous vein or ileojejunal vein) from a prior procedure, radiotherapy, or deep vein thrombosis. Intraoperative PVR was technically success in 100% of the patients. The splenic vein was ligated in seven patients (50%). The perioperative complications included a pancreatic leak, which was not associated with graft pseudoaneurysm, and a chyle leak requiring percutaneous drainage. All grafts were patent at discharge. Three grafts had become thrombosed during postdischarge follow-up, all of which had occurred in the setting of recurrent oncologic disease. The 30-day, and 3-, 12-, and 18-month primary patency rates of PVR with CDTA were 100%, 86%, 71%, and 71%, respectively. Pancreatic cancer remains a highly morbid disease despite surgical resection with curative intent, and early recurrence is the main etiology of PVR thrombosis. In the absence of recurrent oncologic disease, interposition bypass with CDTA for PVR is associated with acceptable patency rates for ≤1 year. Considered with its optimal size, rapid availability, excellent technical success, favorable risk profile, and the absence of harvest site complications, it is a reasonable choice for a conduit in this clinical setting." @default.
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• W3204285311 date "2021-10-01" @default.
• W3204285311 modified "2023-09-23" @default.
• W3204285311 title "Portal Vein Reconstruction With Cadaveric Descending Thoracic Aortic Homograft" @default.
• W3204285311 doi "https://doi.org/10.1016/j.jvs.2021.07.043" @default.
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