• Benedict Kinny-Köster, Joseph R Habib, Floortje van Oosten, Ammar A Javed, John L Cameron, Richard A Burkhart, William R Burns, Jin He, and Christopher L Wolfgang.
• Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MA.
• Ann. Surg. 2023 Jul 1; 278 (1): e94e104e94-e104.

ObjectivesWe analyze successes and failures of pushing the boundaries in vascular pancreatic surgery to establish safety of conduit reconstructions.BackgroundImproved systemic control from chemotherapy in pancreatic cancer is increasing the demand for surgical solutions of extensive local vessel involvement, but conduit-specific data are scarce.MethodsWe identified 63 implanted conduits (41% autologous vessels, 37% allografts, 18% PTFE) in 56 pancreatic resections of highly selected cancer patients between October 2013 and July 2020 from our prospectively maintained database. Assessed parameters were survival, perioperative complications, operative techniques (anatomic and extra-anatomic routes), and conduit patency.ResultsFor vascular reconstruction, 25 arterial and 38 venous conduits were utilized during 39 pancreatoduodenectomies, 14 distal pancreatectomies, and 3 total pancreatectomies. The median postoperative survival was 2 years. A Clavien-Dindo grade ≥IIIa complication was apparent in 50% of the patients with a median Comprehensive Complication Index of 29.6. The 90-day mortality in this highly selected cohort was 9%. Causes of mortality were conduit related in 3 patients, late postpancreatectomy hemorrhage in 1 patient, and early liver metastasis in 1 patient. Image-based patency rates of conduits were 66% and 45% at postoperative days 30 and 90, respectively.ConclusionsOur perioperative mortality of vascular pancreatic surgery with conduits in the arterial or venous system is 9%. Reconstructions are technically feasible with different anatomic and extra-anatomic strategies, while identifying predictors of early conduit occlusion remains challenging. Optimizing reconstructed arterial and venous hemodynamics in the context of pancreatic malignancy will enable long-term survival in more patients responsive to chemotherapies.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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