• Shugo Mizuno, Hiroyuki Kato, Hiroki Yamaue, Tsutomu Fujii, Sohei Satoi, Akio Saiura, Yoshiaki Murakami, Masayuki Sho, Masakazu Yamamoto, and Shuji Isaji.
• Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
• Ann. Surg. 2021 Jul 1; 274 (1): e36-e44.

ObjectiveThe aim of this study was to evaluate how often left-sided portal hypertension (LPH) develops and how LPH affects the long-term outcomes of patients with pancreatic cancer treated with pancreaticoduodenectomy (PD) and resection of the portal vein (PV)/superior mesenteric vein (SMV) confluence.Summary Background DataLittle is known about LPH after PD with resection of the PV/SMV confluence.MethodsOverall, 536 patients who underwent PD with PV/SMV resection were enrolled. Among them, we mainly compared the SVp group [n=285; the splenic vein (SV) was preserved] and the SVr group (n = 227; the SV was divided and not reconstructed).ResultsThe incidence of variceal formation in the SVr group increased until 3 years after PD compared with that in the SVp group (38.7% vs 8.3%, P < 0.001). Variceal bleeding occurred in the SVr group (n = 9: 4.0%) but not in the SVp group (P < 0.001). In the multivariate analysis, the risk factors for variceal formation were liver disease, N factor, conventional PD, middle colic artery resection, and SV division. The only risk factor for variceal bleeding was SV division. The platelet count ratio at 6 months after PD was significantly lower in the SVr group than in the SVp group (0.97 vs 0.82, P < 0.001), and the spleen-volume ratios at 6 and 12 months were significantly higher in the SVr group than in the SVp group (1.38 vs 1.00 and 1.54 vs 1.09; P < 0.001 and P < 0.001, respectively).ConclusionsPD with SV division causes variceal formation, bleeding, and thrombocytopenia.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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