Major venous repair or reconstruction during laparoscopic pancreatic surgery：a single center’s experience

Background: In pancreatic cancer surgery, tumor violation of blood vessels is often considered a contraindication of surgery, especially laparoscopic surgery. We had completed 17 cases of major venous repair or reconstruction during laparoscopic pancreatic surgery, and we considered that this surgical method was safe and feasible based on the skilled laparoscopic techniques. Methods: Between January 2014 and March 2022. A prospective cohort of 17 patients underwent major venous repair or reconstruction. Among them, 15 cases underwent laparoscopic pancreaticoduodenectomy (LPD), 1 case underwent laparoscopic distal pancreatectomy (LDP) and 1 case underwent laparoscopic central pancreatectomy (LCP). In all cases the pancreatic tumor invaded either portal veins (PV) or superior mesenteric veins (SMV). 13 cases underwent laparoscopic venous resection and reconstruction and 4 cases underwent venous repair. Results: Of 17 patients, 10 (58.8%) were male. The mean age was 67.1 (ranged 57-81). All patients successfully completed the operation without transit to open. The average blocking time of venous resection and reconstruction was 30.1 (ranged 15-41) min and the average time of venous wedge resection and stitching was 24.0 (ranged 18-30) min. After surgery, there were no complications such as portal vein stenosis, bleeding, thrombosis and liver failure. 13 patients died within 2 years because of the tumor recurrence, and 4 patients are currently followed by outpatient visits, with no obvious signs of tumor recurrence. Conclusion: Studies have shown that the reconstruction or repair of the major veins under laparoscopic surgery was safe and effective. We recommended that surgeons need to have the basics of open surgery in case laparoscopic surgery cannot be continued, and have proficient laparoscopic surgery techniques combined with extensive training to achieve a learning curve for vascular anastomosis.