The left renal vein: the optimal interposition graft for pancreatic surgery?

Background: Porto-mesenteric venous resection (PMVR) is employed for advanced pancreatic cancer. When primary anastomosis is not feasible, an interposition graft can be used. At our centre, the left renal vein (LRV) is the preferred choice. Methods: A retrospective analysis of patients undergoing pancreatic resection was performed over a 6-year period. Patients who underwent LRV harvest for a PMVR interposition graft were identified. All patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for portal vein thrombosis. Results: Pancreatic resection with PMVR was performed in 183 patients. LRV graft was used in 41 patients. Severe complications were observed in 10 patients. There were two deaths within 90 days of the index operation and six readmissions within 30 days of discharge. Post-operative PV thrombus was observed in 4 patients. The serum creatinine increased by 15.7 % on POD1 and peaked at 30.8 %. The majority of patients had returned to a serum creatinine within 10 % or better of their pre-operative creatinine. Conclusion: We present the largest series using the LRV as an interposition graft for PMVR. We propose that the LRV should be used as the first-choice interposition graft. This graft does not cause long-term renal dysfunction and avoids the morbidity of an additional incision.