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. 2021 Jan 4;21(1):4.
doi: 10.1186/s12893-020-01019-9.

Feasibility of mesentericoportal vein reconstruction by autologous falciform ligament during pancreaticoduodenectomy-cohort study

Yi Shao  1 , Jiaojiao Feng  2 , Yuancong Jiang  1 , Zhenhua Hu  1 , Jian Wu  1 , Min Zhang  1 , Yan Shen  1 , Shusen Zheng  3   4
Affiliations

Feasibility of mesentericoportal vein reconstruction by autologous falciform ligament during pancreaticoduodenectomy-cohort study

Yi Shao et al. BMC Surg. .

Abstract

Background: Mesentericoportal vein (MPV) resection in pancreatic ductal adenocarcinoma (PDAC) surgery has become a common procedure. A few studies had described the use of falciform ligament (FL) for MPV reconstruction and received encouraging preliminary effects.

Aims: This study was designed to explore the feasibility and efficacy of this technique compared with others.

Methods: Patients who underwent pancreaticoduodenectomy (PD) with MPV resection for PDAC from 2009 to 2018 were enrolled. Medical records were retrospectively reviewed, MPV reconstructions using FL were distinguished and compared with other techniques.

Results: 146 patients underwent MPV reconstruction, and 13 received FL venoplasty. Other reconstruction techniques included primary end-to-end anastomosis (primary, n = 30), lateral venorrhaphy (LV, n = 19), polytetrafluoroethylene conduit interposition (PTFE, n = 24), iliac artery (IA) allografts interposition (n = 47), and portal vein (PV) allografts interposition (n = 13). FL group holds the advantages of shortest operation time (p = 0.023), lowest blood loss (p = 0.109), and shortest postoperative hospital stay (p = 0.125). The grouped patency rates of FL, primary, LV, PTFE, IA, and PV were 100%, 90%, 68%, 54%, 68%, and 85% respectively. Comparison displayed that FL had the highest patency rate (p = 0.008) and lowest antiplatelet/anticoagulation proportion (p = 0.000). Complications and long-term survival were similar among different techniques. The median survival time of patent group (24.0 months, 95% CI: 22.0-26.0) was much longer than that of the thrombosed (17.0 months, 95% CI: 13.7-20.3), though without significant difference (P = 0.148).

Conclusions: PD with MPV resection and reconstruction by FL is safe, feasible, and efficacious, it might provide a potential benefit for patients.

Keywords: Falciform ligament; Pancreatic cancer; Patency; Survival; Venous reconstruction technique.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Analysis of overall survival of 146 patients (a) and comparison of survival curves between the patent and the thrombosed (b) by the Kaplan–Meier method
Fig. 2
Fig. 2
Comparison of survival curves among different venous reconstruction techniques by the Kaplan–Meier method
Fig. 3
Fig. 3
Kaplan–Meier estimate showed that poor differentiation (a), tumor size > 2 cm (b), lymph node metastasis (c), and non R0 resection (d) are risk factors for survival time
See this image and copyright information in PMC

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