An innovative option for venous reconstruction after pancreaticoduodenectomy: The left renal vein

Rory L. Smoot, John D. Christein, Michael B. Farnell

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Pancreatic ductal adenocarcinoma has a high mortality rate with limited treatment options. One option is pancreaticoduodenectomy, although complete resection may require venous resection. Pancreaticoduodenectomy with venous resection and reconstruction is becoming a more common practice with many choices for venous reconstruction. We describe the technique of using the left renal vein as a conduit for venous reconstruction during pancreaticoduodenectomy. The technique for use of the left renal vein as an interposition graft for venous reconstruction during pancreaticoduodenectomy is described as well as outcomes for nine patients that have undergone the procedure. Nine patients, seven men, with a mean age of 57 years, have undergone the operation. There were eight interposition grafts and one patch graft. Mean operating time was 7.8 hours, and mean tumor size was 3.4 cm. Eight patients had node-positive disease, and six had involvement of the vein. Mean hospital stay was 14 days and perioperative morbidity included a superficial wound infection, delayed gastric emptying, ascites, and gastrointestinal bleeding in one patient each. Creatinine ranged from 0.8-1.1 mg/dl preoperatively and from 0.7-1.3 mg/dl at discharge. Mean follow-up was 6.8 months with normal creatinine values noted through the follow-up period. Two patients had died during follow-up from recurrent disease at 8.3 and 18.2 months after the operation. The left renal vein provides an additional choice for an autologous graft during pancreaticoduodenectomy with venous resection. The ease of harvesting the graft and maintenance of renal function distinguish its use. .

Original languageEnglish (US)
Pages (from-to)425-431
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume11
Issue number4
DOIs
StatePublished - Apr 2007

Fingerprint

Renal Veins
Pancreaticoduodenectomy
Transplants
Creatinine
Gastric Emptying
Wound Infection
Ascites
Veins
Length of Stay
Reference Values
Adenocarcinoma
Maintenance
Hemorrhage
Morbidity
Kidney
Mortality
Neoplasms

Keywords

  • Left renal vein
  • Pancreatic cancer
  • Pancreaticoduodenectomy
  • Portal vein
  • Superior mesenteric vein
  • Venous resection

ASJC Scopus subject areas

  • Surgery

Cite this

An innovative option for venous reconstruction after pancreaticoduodenectomy : The left renal vein. / Smoot, Rory L.; Christein, John D.; Farnell, Michael B.

In: Journal of Gastrointestinal Surgery, Vol. 11, No. 4, 04.2007, p. 425-431.

Research output: Contribution to journalArticle

Smoot, Rory L. ; Christein, John D. ; Farnell, Michael B. / An innovative option for venous reconstruction after pancreaticoduodenectomy : The left renal vein. In: Journal of Gastrointestinal Surgery. 2007 ; Vol. 11, No. 4. pp. 425-431.
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abstract = "Pancreatic ductal adenocarcinoma has a high mortality rate with limited treatment options. One option is pancreaticoduodenectomy, although complete resection may require venous resection. Pancreaticoduodenectomy with venous resection and reconstruction is becoming a more common practice with many choices for venous reconstruction. We describe the technique of using the left renal vein as a conduit for venous reconstruction during pancreaticoduodenectomy. The technique for use of the left renal vein as an interposition graft for venous reconstruction during pancreaticoduodenectomy is described as well as outcomes for nine patients that have undergone the procedure. Nine patients, seven men, with a mean age of 57 years, have undergone the operation. There were eight interposition grafts and one patch graft. Mean operating time was 7.8 hours, and mean tumor size was 3.4 cm. Eight patients had node-positive disease, and six had involvement of the vein. Mean hospital stay was 14 days and perioperative morbidity included a superficial wound infection, delayed gastric emptying, ascites, and gastrointestinal bleeding in one patient each. Creatinine ranged from 0.8-1.1 mg/dl preoperatively and from 0.7-1.3 mg/dl at discharge. Mean follow-up was 6.8 months with normal creatinine values noted through the follow-up period. Two patients had died during follow-up from recurrent disease at 8.3 and 18.2 months after the operation. The left renal vein provides an additional choice for an autologous graft during pancreaticoduodenectomy with venous resection. The ease of harvesting the graft and maintenance of renal function distinguish its use. .",
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