Pancreatectomy with venous resection and peritoneal patch reconstruction: bridging transplantation and pancreatic surgery to combine the advantages of tangential and segmental resections

Background: Pancreatectomy with venous resection (PVR) is considered standard practice and accomplished with different techniques. Methods: Patients undergoing PVR with portal (PV) and/or superior mesenteric (SMV) vein resection for PDAC between 2015 and 2024 at a high-volume HPB and Liver Transplant Unit were retrospectively analyzed according to ISGPS types. Results: A total of 104 patients underwent PVR: tangential w/primary closure (Type 1 = 30; 29 %) or peritoneal patch (Type 2 = 30; 29 %), segmental w/primary anastomosis (Type 3 = 31; 30 %) or interposition graft (Type 4 = 13; 12 %). Type 2 was mostly used for low (SMV-to-SMV = 37 %) or extended (PV-to-SMV = 50 %) resections (p < 0.001), with lowest rate of splenic vein sacrifice (7 %; p = 0.001). Major morbidity and hemorrhage (PPH) were similar among different ISGPS types (Type 2 = 27 % and 30 %, respectively), as well as mortality (Type 2 = 3 % at 90 days). Prophylactic dose anticoagulation was used in 73 % of Type 2 patients, with 3 % early (≤30 days) and no late (≤1 year) thrombosis. Discussion: The peritoneal patch offers the advantages of both tangential and segmental resections. It can be used for low or extended infiltrations, preserving venous collaterals without sacrificing radicality, with acceptable morbidity and mortality, and near-zero thrombotic events using prophylactic anticoagulation only.