Pancreaticoduodenectomy with venous resection and reconstruction: current surgical techniques and associated postoperative imaging findings

Ammar A. Javed, Karen Bleich, Fabio Bagante, Jin He, Matthew J Weiss, Christopher Wolfgang, Elliot K Fishman

Research output: Contribution to journalArticle

Abstract

Purpose: Introduction of effective neoadjuvant therapy for pancreas cancer has resulted in complex and aggressive operations involving vasculature resection. This results in complicated postoperative CT appearance of vasculature, which in addition to high rate of recurrence makes interpretation of imaging difficult. The aim of this study was to identify patterns of postoperative appearance of portal vein-superior mesenteric vein complex (PV-SMV). Methods: A retrospective study was conducted on patients undergoing pancreaticoduodenectomy with PV-SMV resection and reconstruction (PVR) between 2004 and 2014. Clinicopathological data were collected from a prospectively maintained database. Postoperative CT scans were reviewed to identify patterns of venous and perivenous features. Results: The mean age, of 70 patients included in the study, was 63.0 ± 12.2 years and 37 (52.9%) were males. The median time between surgery and postoperative scan was 10 days (IQR 7–25). Tangential resection with PVR via primary closure or use of a patch was performed in 37 (52.9%) patients while the rest underwent segmental resection with PVR via end-to-end anastomosis or use of a graft. Postoperative patterns of PV-SMV included concentric narrowing (N = 40, 57.1%), eccentric narrowing (N = 19, 27.1%) or partial venous thrombosis (N = 7, 10.0%). Perivenous features included perivenous fluid collection and induration (N = 57, 81.4%) and mass-like soft tissue thickening (N = 13, 18.6%). Long-term follow-up was available on 44 (62.9%) patients of which 28 (63.6%) demonstrated no recurrence of disease. Conclusion: This is a novel study that identifies and categorizes postoperative features of PV-SMV after PVR. These features overlap with those of disease recurrence and their better understanding can results in an accurate interpretation of postoperative imaging.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Aug 21 2017

Fingerprint

Mesenteric Veins
Pancreaticoduodenectomy
Portal Vein
Recurrence
Neoadjuvant Therapy
Pancreatic Neoplasms
Venous Thrombosis
Retrospective Studies
Databases
Transplants

Keywords

  • Pancreaticoduodenectomy
  • Portal vein resection and reconstruction
  • PV-SMV complex
  • Recurrence of pancreas cancer
  • Vascular structure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology

Cite this

@article{ae1a450db1ce452782db834f11435135,
title = "Pancreaticoduodenectomy with venous resection and reconstruction: current surgical techniques and associated postoperative imaging findings",
abstract = "Purpose: Introduction of effective neoadjuvant therapy for pancreas cancer has resulted in complex and aggressive operations involving vasculature resection. This results in complicated postoperative CT appearance of vasculature, which in addition to high rate of recurrence makes interpretation of imaging difficult. The aim of this study was to identify patterns of postoperative appearance of portal vein-superior mesenteric vein complex (PV-SMV). Methods: A retrospective study was conducted on patients undergoing pancreaticoduodenectomy with PV-SMV resection and reconstruction (PVR) between 2004 and 2014. Clinicopathological data were collected from a prospectively maintained database. Postoperative CT scans were reviewed to identify patterns of venous and perivenous features. Results: The mean age, of 70 patients included in the study, was 63.0 ± 12.2 years and 37 (52.9{\%}) were males. The median time between surgery and postoperative scan was 10 days (IQR 7–25). Tangential resection with PVR via primary closure or use of a patch was performed in 37 (52.9{\%}) patients while the rest underwent segmental resection with PVR via end-to-end anastomosis or use of a graft. Postoperative patterns of PV-SMV included concentric narrowing (N = 40, 57.1{\%}), eccentric narrowing (N = 19, 27.1{\%}) or partial venous thrombosis (N = 7, 10.0{\%}). Perivenous features included perivenous fluid collection and induration (N = 57, 81.4{\%}) and mass-like soft tissue thickening (N = 13, 18.6{\%}). Long-term follow-up was available on 44 (62.9{\%}) patients of which 28 (63.6{\%}) demonstrated no recurrence of disease. Conclusion: This is a novel study that identifies and categorizes postoperative features of PV-SMV after PVR. These features overlap with those of disease recurrence and their better understanding can results in an accurate interpretation of postoperative imaging.",
keywords = "Pancreaticoduodenectomy, Portal vein resection and reconstruction, PV-SMV complex, Recurrence of pancreas cancer, Vascular structure",
author = "Javed, {Ammar A.} and Karen Bleich and Fabio Bagante and Jin He and Weiss, {Matthew J} and Christopher Wolfgang and Fishman, {Elliot K}",
year = "2017",
month = "8",
day = "21",
doi = "10.1007/s00261-017-1290-5",
language = "English (US)",
pages = "1--11",
journal = "Abdominal Radiology",
issn = "2366-004X",
publisher = "Springer New York",

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TY - JOUR

T1 - Pancreaticoduodenectomy with venous resection and reconstruction

T2 - current surgical techniques and associated postoperative imaging findings

AU - Javed, Ammar A.

AU - Bleich, Karen

AU - Bagante, Fabio

AU - He, Jin

AU - Weiss, Matthew J

AU - Wolfgang, Christopher

AU - Fishman, Elliot K

PY - 2017/8/21

Y1 - 2017/8/21

N2 - Purpose: Introduction of effective neoadjuvant therapy for pancreas cancer has resulted in complex and aggressive operations involving vasculature resection. This results in complicated postoperative CT appearance of vasculature, which in addition to high rate of recurrence makes interpretation of imaging difficult. The aim of this study was to identify patterns of postoperative appearance of portal vein-superior mesenteric vein complex (PV-SMV). Methods: A retrospective study was conducted on patients undergoing pancreaticoduodenectomy with PV-SMV resection and reconstruction (PVR) between 2004 and 2014. Clinicopathological data were collected from a prospectively maintained database. Postoperative CT scans were reviewed to identify patterns of venous and perivenous features. Results: The mean age, of 70 patients included in the study, was 63.0 ± 12.2 years and 37 (52.9%) were males. The median time between surgery and postoperative scan was 10 days (IQR 7–25). Tangential resection with PVR via primary closure or use of a patch was performed in 37 (52.9%) patients while the rest underwent segmental resection with PVR via end-to-end anastomosis or use of a graft. Postoperative patterns of PV-SMV included concentric narrowing (N = 40, 57.1%), eccentric narrowing (N = 19, 27.1%) or partial venous thrombosis (N = 7, 10.0%). Perivenous features included perivenous fluid collection and induration (N = 57, 81.4%) and mass-like soft tissue thickening (N = 13, 18.6%). Long-term follow-up was available on 44 (62.9%) patients of which 28 (63.6%) demonstrated no recurrence of disease. Conclusion: This is a novel study that identifies and categorizes postoperative features of PV-SMV after PVR. These features overlap with those of disease recurrence and their better understanding can results in an accurate interpretation of postoperative imaging.

AB - Purpose: Introduction of effective neoadjuvant therapy for pancreas cancer has resulted in complex and aggressive operations involving vasculature resection. This results in complicated postoperative CT appearance of vasculature, which in addition to high rate of recurrence makes interpretation of imaging difficult. The aim of this study was to identify patterns of postoperative appearance of portal vein-superior mesenteric vein complex (PV-SMV). Methods: A retrospective study was conducted on patients undergoing pancreaticoduodenectomy with PV-SMV resection and reconstruction (PVR) between 2004 and 2014. Clinicopathological data were collected from a prospectively maintained database. Postoperative CT scans were reviewed to identify patterns of venous and perivenous features. Results: The mean age, of 70 patients included in the study, was 63.0 ± 12.2 years and 37 (52.9%) were males. The median time between surgery and postoperative scan was 10 days (IQR 7–25). Tangential resection with PVR via primary closure or use of a patch was performed in 37 (52.9%) patients while the rest underwent segmental resection with PVR via end-to-end anastomosis or use of a graft. Postoperative patterns of PV-SMV included concentric narrowing (N = 40, 57.1%), eccentric narrowing (N = 19, 27.1%) or partial venous thrombosis (N = 7, 10.0%). Perivenous features included perivenous fluid collection and induration (N = 57, 81.4%) and mass-like soft tissue thickening (N = 13, 18.6%). Long-term follow-up was available on 44 (62.9%) patients of which 28 (63.6%) demonstrated no recurrence of disease. Conclusion: This is a novel study that identifies and categorizes postoperative features of PV-SMV after PVR. These features overlap with those of disease recurrence and their better understanding can results in an accurate interpretation of postoperative imaging.

KW - Pancreaticoduodenectomy

KW - Portal vein resection and reconstruction

KW - PV-SMV complex

KW - Recurrence of pancreas cancer

KW - Vascular structure

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