多药化疗的进步扩大了胰腺癌的手术适应症。尽管胰十二指肠切除术 (PD) 联合门静脉切除术 (PVR) 已被广泛采用，但远端胰腺切除术 (DP) 联合 PVR 因其技术复杂性而仍然很少实施。本研究旨在评估 DP-PVR 与 PD-PVR 相比治疗胰体癌的可行性，重点关注 PV 并发症，并在需要 DP-PVR 时提供最佳重建技术。对连续的胰体癌进行了回顾性评价2005 年至 2020 年间接受 PVR 胰腺切除术的患者。基于动脉和 PV 之间的解剖关系的算法用于最佳手术选择。在 119 名患者中，32 名患者接受了 DP-PVR，87 名患者接受了 PD-PVR。 DP-PVR 病例采用了各种重建技术，包括补片重建、移植物插入和楔形切除。大多数 PD-PVR 病例涉及端对端吻合。 DP-PVR 中 PVR 的长度较短（25 毫米与 40 毫米；p < 0.001）。尽管 DP-PVR 中 Clavien-Dindo ≥3a 较高 (p = 0.002)，但住院患者死亡率和 R0 状态相似。 DP-PVR 中PV 完全闭塞的发生率高于 PD-PVR（21.9% vs. 1.1%；p < 0.001）。 PVR 长度的截止值 30 mm 被确定为 DP-PVR 后非复发相关 PV 闭塞的预测。两组在复发或总生存方面没有显着差异。DP-PVR 的闭塞率和术后并发症发生率高于 PD-PVR。这些发现支持了所提出的算法，并强调了当认为有必要进行 DP-PVR 时细致的手术操作的重要性。© 2023。外科肿瘤学会。

Advancements in multiagent chemotherapy have expanded the surgical indications for pancreatic cancer. Although pancreaticoduodenectomy (PD) with portal vein resection (PVR) has become widely adopted, distal pancreatectomy (DP) with PVR remains rarely performed because of its technical complexity. This study was designed to assess the feasibility of DP-PVR compared with PD-PVR for pancreatic body cancers, with a focus on PV complications and providing optimal reconstruction techniques when DP-PVR is necessary.A retrospective review was conducted on consecutive pancreatic body cancer patients who underwent pancreatectomy with PVR between 2005 and 2020. An algorithm based on the anatomical relationship between the arteries and PV was used for optimal surgical selection.Among 119 patients, 32 underwent DP-PVR and 87 underwent PD-PVR. Various reconstruction techniques were employed in DP-PVR cases, including patch reconstruction, graft interposition, and wedge resection. The majority of PD-PVR cases involved end-to-end anastomosis. The length of PVR was shorter in DP-PVR (25 vs. 40 mm; p < 0.001). Although Clavien-Dindo ≥3a was higher in DP-PVR (p = 0.002), inpatient mortality and R0 status were similar. Complete PV occlusion occurred more frequently in DP-PVR than in PD-PVR (21.9% vs. 1.1%; p < 0.001). A cutoff value of 30 mm for PVR length was determined to be predictive of nonrecurrence-related PV occlusion after DP-PVR. The two groups did not differ significantly in recurrence or overall survival.DP-PVR had higher occlusion and postoperative complication rates than PD-PVR. These findings support the proposed algorithm and emphasize the importance of meticulous surgical manipulation when DP-PVR is deemed necessary.© 2023. Society of Surgical Oncology.