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Observational Study
. 2023 Nov;30(12):7700-7711.
doi: 10.1245/s10434-023-13847-z. Epub 2023 Aug 19.

Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management

Thomas F Stoop  1   2   3   4 , André von Gohren  1 , Jennie Engstrand  1 , Ernesto Sparrelid  1 , Stefan Gilg  1 , Marco Del Chiaro  4 , Poya Ghorbani  5
Affiliations
Observational Study

Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management

Thomas F Stoop et al. Ann Surg Oncol. 2023 Nov.

Abstract

Background: Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP.

Methods: This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC.

Results: The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142-4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175-0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034-4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772-24.362).

Conclusions: After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.

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Conflict of interest statement

Marco Del Chiaro has been awarded with an industry grant (Haemonetics, Inc) to conduct a multicenter study to evaluate the prognostic implications of TEG in pancreatic cancer. He is co-principal investigator of a Boston Scientific-sponsored international multicenter study on the use of intraoperative pancreatoscopy for patients with IPMN. The remaining authors have no conflicts of interests.

References

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