Study On The Adverse Events Of Portal-superior Mesenteric Vein Resection And Reconstruction For Patients With Hepato-biliary-pancreatic Tumors

Background and aims Advanced cholangiocellular liver cancer, perihilar cholangiocarcinoma and pancreatic cancer can invade the portal vein (PV) and superior mesenteric vein (SMV), which was previously considered as a contraindication to operation. Accumulating yet limiting evidence has shown a relative security of portal-superior mesenteric vein (PV-SMV) resection and reconstruction (PSRR). Currently a growing number of PSRR is performed worldwide. Strategy of PSRR varies with resection locations and to date no reports have focused on a clinically effective classification system for PSRR. Here, we propose a classification system for PSRR and report the preliminary clinical significance of perioperative security.Methods All patients who had cholangiocellular liver cancer, perihilar cholangiocarcinoma or pancreatic cancer underwent PSRR from July2008to September2012in First or Second Affiliated Hospital, Zhejiang University School of Medicine were collected, together with the same amount of patients underwent tumor resection without PSRR as case controls. All the operations were conducted by Prof. Liang Tingbo. We classified the PSRR into three types and five subtypes (IM, IL, IR, â…¡ and â…¢) based on our clinical experience and anatomy of the PV-SMV. The associations among PSRR type, post-operative mortality, morbidity, hospital stay, pre-and intra-operation traits as well as demographic characteristics were analyzed.Results Totally44patients in both groups was included. One patient died in each group (P=0.33), and the morbidity was65.9%and59.1%in case and control group, respectively (P=0.46). PSRR type and anastomotic time are both associated with perioperative morbidity. Long anastomotic time attributes to higher morbidity (P=0.034) and higher grade of complications (P=0.013). PSRR types were not significant associated with anastomotic time (P=0.39), though subtype IR seemed extremely tricky and time-consuming in some cases. Different PSRR types do not have significant difference in morbidity (P=0.64) but subtype IR has higher grade of complications (P=0.0012).Conclusions The new classification system for PSRR may be valuable for hepato-pancreato-biliary surgeon training, and along with anastomotic time offers a predictable factor for morbidity after operation. Care should be taken when subtype IR is used or/and long anastomotic time is expected in surgical treatment of liver cancer and perihilar cholangiocarcinoma.