Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer
Background: This study aims to evaluate sinistral portal hypertension (SPH) development and its clinical impact on the long-term outcomes of patients with pancreatic cancer who underwent surgical resection with splenic vein (SV) ligation. Methods: Data from 94 consecutive patients who underwent panc...
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MDPI AG
2022-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/19/4853 |
| _version_ | 1797480138632331264 |
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| author | Sung Hyun Kim Seung-Seob Kim Ho Kyoung Hwang Woo Jung Lee Chang Moo Kang |
| author_facet | Sung Hyun Kim Seung-Seob Kim Ho Kyoung Hwang Woo Jung Lee Chang Moo Kang |
| author_sort | Sung Hyun Kim |
| collection | DOAJ |
| description | Background: This study aims to evaluate sinistral portal hypertension (SPH) development and its clinical impact on the long-term outcomes of patients with pancreatic cancer who underwent surgical resection with splenic vein (SV) ligation. Methods: Data from 94 consecutive patients who underwent pancreatoduodenectomy (PD) with vascular resection for pancreatic cancer from 2008 to 2019 were retrospectively collected. The patients were divided into two groups according to whether the SV was preserved or ligated during the surgery. Their computed tomography images were serially reviewed (preoperative, 6-, 12-, and 24-months postoperative) with clinical parameters. The degree of variceal formation (variceal score) and splenomegaly were assessed, and the oncologic outcomes were compared between the two groups. Variceal score in the SV ligation group was significantly higher than that in the SV saving group at the same postoperative periods (SV saving vs. ligation: 12 months, 0.9 ± 1.3 vs. 3.5 ± 2.2, <i>p</i> < 0.001; 24 months, 1.4 ± 1.8 vs. 4.0 ± 3.4, <i>p</i> = 0.009). Clinically relevant variceal bleeding was noted in one patient from the SV ligation group (SV saving vs. ligation: 0.0% vs. 3.1%, <i>p</i> = 0.953). In survival analysis, there was no significant difference between the two groups (DFS; SV saving vs. ligation: 13.0 (11.1–14.9) months vs. 13.0 (10.4–15.6) months, <i>p</i> = 0.969, OS; SV saving vs. ligation: 35.0 (19.9–50.1) months vs. 27.0 (11.6–42.4) months, <i>p</i> = 0.417). Although SV ligation induced SPH during PD for pancreatic cancer, it did not lead to clinically significant long-term complications. In addition, it did not impact the long-term survival of patients with resected pancreatic head cancer. |
| first_indexed | 2024-03-09T21:55:30Z |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T21:55:30Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
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| series | Cancers |
| spelling | doaj.art-2c4214b402f34d1ba84d0e3b157413782023-11-23T19:57:42ZengMDPI AGCancers2072-66942022-10-011419485310.3390/cancers14194853Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic CancerSung Hyun Kim0Seung-Seob Kim1Ho Kyoung Hwang2Woo Jung Lee3Chang Moo Kang4Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, KoreaPancreaticobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul 03722, KoreaDepartment of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, KoreaBackground: This study aims to evaluate sinistral portal hypertension (SPH) development and its clinical impact on the long-term outcomes of patients with pancreatic cancer who underwent surgical resection with splenic vein (SV) ligation. Methods: Data from 94 consecutive patients who underwent pancreatoduodenectomy (PD) with vascular resection for pancreatic cancer from 2008 to 2019 were retrospectively collected. The patients were divided into two groups according to whether the SV was preserved or ligated during the surgery. Their computed tomography images were serially reviewed (preoperative, 6-, 12-, and 24-months postoperative) with clinical parameters. The degree of variceal formation (variceal score) and splenomegaly were assessed, and the oncologic outcomes were compared between the two groups. Variceal score in the SV ligation group was significantly higher than that in the SV saving group at the same postoperative periods (SV saving vs. ligation: 12 months, 0.9 ± 1.3 vs. 3.5 ± 2.2, <i>p</i> < 0.001; 24 months, 1.4 ± 1.8 vs. 4.0 ± 3.4, <i>p</i> = 0.009). Clinically relevant variceal bleeding was noted in one patient from the SV ligation group (SV saving vs. ligation: 0.0% vs. 3.1%, <i>p</i> = 0.953). In survival analysis, there was no significant difference between the two groups (DFS; SV saving vs. ligation: 13.0 (11.1–14.9) months vs. 13.0 (10.4–15.6) months, <i>p</i> = 0.969, OS; SV saving vs. ligation: 35.0 (19.9–50.1) months vs. 27.0 (11.6–42.4) months, <i>p</i> = 0.417). Although SV ligation induced SPH during PD for pancreatic cancer, it did not lead to clinically significant long-term complications. In addition, it did not impact the long-term survival of patients with resected pancreatic head cancer.https://www.mdpi.com/2072-6694/14/19/4853pancreatic cancersinistral portal hypertensionsplenic vein ligationsurvivalvarices |
| spellingShingle | Sung Hyun Kim Seung-Seob Kim Ho Kyoung Hwang Woo Jung Lee Chang Moo Kang Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer Cancers pancreatic cancer sinistral portal hypertension splenic vein ligation survival varices |
| title | Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer |
| title_full | Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer |
| title_fullStr | Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer |
| title_full_unstemmed | Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer |
| title_short | Should the Splenic Vein Be Preserved—Fate of Sinistral Portal Hypertension after Pancreatoduodenectomy with Vascular Re-Section for Pancreatic Cancer |
| title_sort | should the splenic vein be preserved fate of sinistral portal hypertension after pancreatoduodenectomy with vascular re section for pancreatic cancer |
| topic | pancreatic cancer sinistral portal hypertension splenic vein ligation survival varices |
| url | https://www.mdpi.com/2072-6694/14/19/4853 |
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