Severe morbidity following pancreatectomy with vascular reconstruction: impact of intraoperative vascular events and grafted venous reconstructions.

Background: Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied. Methods: We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses. Results: Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien-Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3-14.6, p = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5-280, p = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions. Conclusion: Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.