Background : Resection of the porto-mesenteric axis is increasingly performed with pancreatectomies and remains the only chance to obtain a negative margin in cases where the vein is encased or involved. This study reports perioperative outcomes of portal vein resections (PVR) in pancreatectomies from a tertiary-level centre in India and aims to assess factors predicting major complications (MC).

Methods : Clinicodemographic, radiological, surgical and postoperative data of PVR cases, from January 2015 to September 2023, was obtained from a prospectively maintained database of pancreatic resections. Univariate and multivariate analyses were performed to study MC (Clavein Dindo Grade 3b and above) following PVR.

Results : Of the 1743 pancreatectomies, 122(7.0%) were PVR, with 9(0.05%) being artery and vein resections. Of these, 68(55.7%) tumours were classified as borderline resectable and 15(11.5%) as locally advanced. The majority were pancreatoduodenectomies (104,87.7%), followed by distal resections (9,7.4%) and total pancreatectomy (6,4.9%). ISGPS type 1/2 PVR were 31(25.4%) and type 3/4 were (70.5%). Five patients underwent vein resection without reconstruction. The rate of MC was 18.8%(n=23), 90-day mortality rate was 7.4%. After excluding patients with concomitant arterial resections, age of the patient, median blood loss, a pancreatoduodenectomy over a distal or total pancreatectomy, and resection of an additional organ were found significant on univariate analysis. On multivariate analysis, a soft pancreas (OR=5.224, 95%CI 1.4-19.5, p=0.014) was the only independent predictive factor.

Conclusions : The pancreatic texture remains an important predictor of major complications in patients undergoing PVR. Resection of an additional organ was also associated with worse outcomes but did not reach statistical significance.