S. L. Zettervall1, J. Holzmacher1, T. Ju1, G. Werba1, B. Huysman1, P. Lin1, A. Sidawy1, K. Vaziri1 1George Washington University School Of Medicine And Health Sciences,Surgery,Washington, DC, USA
Introduction: Vascular reconstruction during pancreaticoduodenectomy is increasingly utilized to improve pancreatic cancer resectability. However, very few multi-institutional studies have evaluated the morbidity and mortality of arterial and venous resection with reconstruction during this procedure.
Methods: A retrospective analysis of prospectively collected data was performed utilizing the targeted pancreas module of the National Surgical Quality Improvement Program (NSQIP) for patients undergoing pancreaticoduodenectomy from 2012-2014. Demographics, comorbidities, and 30-day outcomes were compared among patients who underwent venous or arterial reconstruction and no vascular reconstruction. Multivariate analysis was utilized to adjust for differences in demographic and operative characteristics.
Results: 3002 patients were included in NSQIP in the time period studied: 384 with venous reconstruction, 52 with arterial reconstruction, and 2566 without. Patients who underwent both venous and arterial reconstruction were excluded (N=81). Compared to patients without reconstruction, those with venous reconstruction had more congestive heart failure (0.2% vs. 1.8%, P <.01), and those with arterial reconstruction had higher rates of pulmonary disease (11.5 vs. 4.5%, P =0.02). Pre-operative chemotherapy was more common in both venous (34% vs 12%, P < .01), and arterial reconstruction (21% vs 12%, P < .04). On multivariate analysis, there was also no increase in morbidity or mortality following venous reconstruction, compared to those without reconstruction. In contrast, using multivariate analysis, arterial reconstruction was associated with increased 30-day mortality with an Odds Ratio (OR): 6.7, 95%; Confidence Interval (CI): 1.8-25. Also morbidity was increased as represented with return to the operating room (OR: 4.5, 95%; CI: 1.5-15), pancreatic fistula (OR: 4.4, 95%; CI: 1.7-11), and reintubation (OR: 3.9, 95%; CI: 1.1-14).
Conclusion: These findings suggest that venous reconstruction, may be considered to improve survival in patients previously thought of as unresectable due to venous involvement. Careful consideration should be made prior to arterial reconstruction given the significant increase in perioperative complications and death within 30-day from operative procedure.
