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Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection

BACKGROUND: In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH). METHODS: The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection af...

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Autores principales: Gyoten, Kazuyuki, Mizuno, Shugo, Nagata, Motonori, Ogura, Toru, Usui, Masanobu, Isaji, Shuji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504262/
https://www.ncbi.nlm.nih.gov/pubmed/28258459
http://dx.doi.org/10.1007/s00268-017-3916-8
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author Gyoten, Kazuyuki
Mizuno, Shugo
Nagata, Motonori
Ogura, Toru
Usui, Masanobu
Isaji, Shuji
author_facet Gyoten, Kazuyuki
Mizuno, Shugo
Nagata, Motonori
Ogura, Toru
Usui, Masanobu
Isaji, Shuji
author_sort Gyoten, Kazuyuki
collection PubMed
description BACKGROUND: In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH). METHODS: The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence. RESULTS: The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05). CONCLUSION: In PD with resection of PV–SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.
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spelling pubmed-55042622017-07-25 Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection Gyoten, Kazuyuki Mizuno, Shugo Nagata, Motonori Ogura, Toru Usui, Masanobu Isaji, Shuji World J Surg Original Scientific Report BACKGROUND: In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH). METHODS: The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence. RESULTS: The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05). CONCLUSION: In PD with resection of PV–SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it. Springer International Publishing 2017-03-03 2017 /pmc/articles/PMC5504262/ /pubmed/28258459 http://dx.doi.org/10.1007/s00268-017-3916-8 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Scientific Report
Gyoten, Kazuyuki
Mizuno, Shugo
Nagata, Motonori
Ogura, Toru
Usui, Masanobu
Isaji, Shuji
Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title_full Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title_fullStr Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title_full_unstemmed Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title_short Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection
title_sort significance of simultaneous splenic artery resection in left-sided portal hypertension after pancreaticoduodenectomy with combined portal vein resection
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504262/
https://www.ncbi.nlm.nih.gov/pubmed/28258459
http://dx.doi.org/10.1007/s00268-017-3916-8
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