Portomesenteric Venous Thrombosis after Pancreatic Cancer Surgery with Venous Resection and Reconstruction

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.