Portal vein reconstruction with bovine pericardium: a comparative analysis of postoperative outcomes in pancreatic surgery.

Purpose: Extended pancreatic resections with venous reconstruction are increasingly performed for borderline resectable pancreatic cancer. Various venous reconstruction techniques have been described. At our center, reconstruction is performed using bovine pericardium patches. So far, few studies reported outcomes using this technique in the field of pancreatic surgery.

Methods: Data of consecutive pancreatoduodenectomies between January 1st 2015 and December 31st 2023 were analyzed retrospectively. Postoperative complications were graded by the Clavien-Dindo Classification, Comprehensive Complication Index (CCI) and complications specific to pancreatic resections as recommended and published by the International Study Group of Pancreatic Surgery (ISGPS).

Results: Pancreatoduodenectomy included portal vein resection (PVR) in 23 patients compared to 95 patients without PVR. Patient age and comorbidities were similarly distributed between groups. Pancreatic adenocarcinoma was more prevalent in the PVR-group compared to no-PVR (87% vs. 58%, p = 0.009). Operation time and blood loss were both increased with PVR (median: 416 min vs. 315 min and 300 ml vs. 150 ml, p < 0.001 for both comparisons). Within ISGPS defined complications, grade B delayed gastric emptying and grade A postoperative hemorrhage were increased with PVR (N = 22 vs. N = 1, p = 0.001 and N = 13 vs. N = 0, p = 0.007). All other ISGPS complications, overall complications, CCI, 30-day and 90-day mortality were similar between groups. Out of 23 patients with PVR, early and late thrombosis occurred in one patient each.

Conclusion: Portal vein reconstruction with bovine pericardium is feasible with comparable overall morbidity and mortality compared to pancreatoduodenectomy without PVR.