OBJECTIVE To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR). SUMMARY BACKGROUND DATA Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated. METHODS This study included pancreatic cancer patients undergoing any type of pancreatic resection with PVR at the University of Colorado Hospital between January 2012 and June 2023. The study period was divided based on the implementation of local standardization of PVR techniques in August 2018. PVT was classified as early or late (≤ or >30 d postoperatively). Risk factors for late PVT were assessed with Cox regression models. RESULTS Among 152 patients, 3.3% (n=5) developed early PVT. Its incidence decreased from 12% (n=3/25) to 1.6% (n=2/127) after technical standardization (P=0.03). Of 130 patients with available postoperative imaging, 21.5% (n=28) developed late PVT at a median of 7.4 months from surgery. Late PVT was frequently diagnosed with local recurrence (75%) and was associated with shorter recurrence-free survival (median 9.0 vs. 16.3 mo, P=0.014). Multivariable analysis showed that neoadjuvant radiotherapy (hazard ratio [HR], 2.19; 95% CI, 1.02-4.67) and local recurrence (HR, 5.21; 95% CI, 2.18-12.4) were associated with an increased risk of late PVT. CONCLUSIONS Early PVT after pancreatectomy with PVR is rare. Late PVT is associated with neoadjuvant radiotherapy and local recurrence. These findings may inform risk assessment in pancreatic cancer patients undergoing PVR.

中文翻译：

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胰腺癌手术伴静脉切除和重建后的门肠静脉血栓形成：时间、发生率和风险因素。


目的 探讨门肠静脉切除术 （PVR） 胰腺癌手术后门肠静脉血栓形成 （PVT） 的发生率及危险因素。摘要 背景数据 PVR 胰腺癌手术可能因 PVT 而复杂化，但 PVT 的长期关联、危险因素和后果尚未明确阐明。方法 本研究包括 2012 年 1 月至 2023 年 6 月期间在科罗拉多大学医院接受任何类型的胰腺 PVR 切除术的胰腺癌患者。研究期根据 2018 年 8 月 PVR 技术本地标准化的实施情况进行划分。PVT 分为早期或晚期 （术后 ≤ 或 >30 d）。使用 Cox 回归模型评估晚期 PVT 的危险因素。结果 在 152 例患者中，3.3% （n=5） 发生早期 PVT。技术标准化后，其发生率从 12% （n=3/25） 下降到 1.6% （n=2/127） （P=0.03）。在 130 例术后影像学检查可用的患者中，21.5% （n=28） 在手术后中位 7.4 个月时发生晚期 PVT。晚期 PVT 经常被诊断为局部复发 （75%），并且与较短的无复发生存期相关 （中位数 9.0 vs. 16.3 个月，P = 0.014）。多变量分析显示，新辅助放疗 （风险比 [HR]，2.19;95% CI，1.02-4.67）和局部复发 （HR，5.21;95% CI，2.18-12.4） 与晚期 PVT 风险增加相关。结论 胰腺切除术后 PVR 后早期 PVT 很少见。晚期 PVT 与新辅助放疗和局部复发有关。这些发现可能为接受 PVR 的胰腺癌患者的风险评估提供信息。