Table 3.
Permeability of venous reconstructions after resection for cancer; results of literature (EEA, end to end anastomosis; PTFE, poly tetra fluoro ethylene graft).
| References | VR | Reconstruction | Follow-up average (months) | Permeability (% and median duration) | Thrombosis during hospitalization | Thrombosis |
|---|---|---|---|---|---|---|
| Chu et al. 2010 (61)* | 33 | PTFE | 14 | 76% 21 months | 3 | 5 |
| Krepline et al. (63)** |
43 | all types | 13 | 91% | – | 4 |
| Liao et al. (62)£ |
36 | EEA | – | 6/12 months 94–86% |
– | 5 |
| 29 | PTFE | – | 6/12 months 88–83% |
1 | 5 | |
| Fuji et al. (75)$ | 197 | EEA | – | – | 3 | 18 |
US review (1994–2009); (PTFE—median diameter: 12 mm (8-20); “ringed” in 73% of cases). No graft infection. Mortality: 2 patients (6%) including 1 of 3 patients with early thrombosis.
Suture (7, 16%), venous saphenous “patch” (9, 21%), terminal anastomosis (13, 30%), jugular graft (14, 33%); all patients received aspirin or low molecular weight heparin (LMWH); 4 thromboses: 2 on LMWH and 2 on aspirin within a median of 72 days (16-238).
3-center study in China (2007–2012); 76 RV (65 for PDAC). Thrombosis after PTFE on day 4 was treated with thrombolysis (heparin + urokinase). The delay for late thrombosis was 3, 3, 5, 5, 11, and 17 months in the PTFE group and 4, 5, 8, 12, and 22 months in the TA group. Morbidity: 29% PTFE vs. 33% TA; mortality: 3% PTFE vs. 7% TA (NS despite PTFE for larger tumors (p = 0.016), longer operating time (p < 0.001) and greater bleeding (p = 0.04). There was no graft infection. There was no difference in survival for the 65 PDACs (29/65 PTFE and 36/65 TA; median 11 vs. 12 months; survival at 1 and 3 years: 36 and 4 vs. 36 and 9%, respectively).
Series conducted in Japan: 197 VRs (197/810 pancreatectomies; 2000–2014); controlled permeability every 4–6 months to assess the rate of severe secondary anastomotic stenosis (≥70% of the caliber; AUC = 0.83); 3 acute thromboses after immediate surgery: 2 reoperations (1 reattempt; 1 venous graft); 1 conservatively treated). Excluding the 21 stenoses related to early neoplastic recurrence, 18 patients had severe, symptomatic secondary stenosis in 16 cases (refractory ascites: 9, encephalopathies: 4, and gastrointestinal hemorrhages: 7, including 2 treated with a stent and 1 by mesocaval shunt). The multivariate analysis showed independent factors for the occurrence of severe stenosis: the surgical duration (≥520 min; HR = 15.24; 95% CI: 3.75–104.4; p < 0.001) and the resected vein length >3 cm (HR = 5.96; 95% CI: 1.8–22.7; p = 0.003). This study suggested that an autologous graft could reduce this rate.