Impact of Lumbar Vein Preservation on Postoperative Renal Function Following Left Renal Vein Graft Harvesting in Pancreatic Surgery.

BACKGROUND

Left renal vein (LtRV) graft harvesting for portal vein (PV) reconstruction during pancreatic surgery is considered to have limited impact on renal function due to the development of collateral venous pathways. However, it was hypothesized that failure to preserve the lumbar vein (LuV), a tributary of the LtRV, may cause renal dysfunction, as the LuV has direct communications with the azygos venous system and may serve as an effective collateral venous pathway. The association between preservation of LtRV tributaries and renal function was investigated.

METHODS

This single-center retrospective study reviewed patients who underwent pancreatic surgery with International Study Group of Pancreatic Surgery type 4 circumferential PV reconstruction using vascular grafts during 2015-2026. Renal function was compared between patients who underwent reconstruction using LtRV graft (LtRV graft group) and those who received other types of grafts (non-LtRV graft group). In the LtRV graft group, renal function was further analyzed according to preservation of the LuV (LuV vs. non-LuV groups) and the left adrenal vein (LtAV; LtAV vs. non-LtAV groups).

RESULTS

No significant difference in the decline of estimated glomerular filtration rate (eGFR) was observed between the non-LtRV graft group (n = 26) and the LtRV graft group (n = 29). Within the LtRV graft group, 5 and 23 patients were assigned to the non-LuV and LuV groups, respectively. In the non-LuV group, postoperative acute kidney injury occurred significantly more frequently and the median decrease in eGFR of more than 20 mL/min/1.73 m2 persisted until 2 months postoperatively. The decline in eGFR and the increase in creatinine on PODs 3, 7, and 28 were significantly greater in the non-LuV group than in the LuV group. Renal scintigraphy demonstrated poorer left renal function in the non-LuV group. No significant difference in renal function was observed between the non-LtAV (n = 10) and LtAV (n = 18) groups.

CONCLUSIONS

Preservation of the LuV may be important for preventing renal dysfunction after LtRV graft harvesting. Considering the need for early postoperative adjuvant chemotherapy, LtRV grafts should be carefully considered in patients without the LuV and with a preoperative eGFR < 50 mL/min/1.73 m2.