TY - JOUR
T1 - Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy
T2 - An Underestimated Complication Requiring Standardized Identification, Grading, and Management
AU - Stoop, Thomas F.
AU - von Gohren, André
AU - Engstrand, Jennie
AU - Sparrelid, Ernesto
AU - Gilg, Stefan
AU - del Chiaro, Marco
AU - Ghorbani, Poya
N1 - Funding Information: The authors would like to thank statistician Susan van Dieren (Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands) for supervising the statistical analyses. Publisher Copyright: © 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Background: Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP. Methods: This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC. Results: The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362). Conclusions: After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.
AB - Background: Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP. Methods: This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC. Results: The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142–4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175–0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034–4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772–24.362). Conclusions: After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.
UR - http://www.scopus.com/inward/record.url?scp=85167522574&partnerID=8YFLogxK
U2 - https://doi.org/10.1245/s10434-023-13847-z
DO - https://doi.org/10.1245/s10434-023-13847-z
M3 - Article
C2 - 37596448
SN - 1068-9265
VL - 30
SP - 7700
EP - 7711
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 12
ER -