{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T01:27:28Z","timestamp":1749778048265},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T00:00:00Z","timestamp":1537142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T00:00:00Z","timestamp":1537142400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"name":"Nara Medical University Grant-in-Aid for Collaborative Research Projects"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,2,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Late\u2010onset gastrointestinal hemorrhage after pancreatoduodenectomy (PD) occasionally occurs repeatedly or leads to a serious condition. This retrospective study aimed to clarify its frequency and pathogenesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 147 consecutive patients who underwent PD for pancreatic cancer between 2006 and 2014 were evaluated. Patients were divided into two groups according to the occurrence of late\u2010onset gastrointestinal hemorrhage on postoperative day 100 or later. Furthermore, recurrence and portal vein (PV) hemodynamics were thoroughly reevaluated by computed tomography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven patients experienced late\u2010onset gastrointestinal hemorrhage. The bleeding sites were gastrojejunostomy in four patients, choledochojejunostomy in two, transverse colic marginal vein in one, and unknown in four. The median occurrence time of late\u2010onset gastrointestinal hemorrhage was 13.3\u00a0months after PD. PV occlusion (63.6 vs. 8.9%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), no patency of PV\u2013splenic vein (SPV) confluence (54.5 vs. 12.7%; <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and SPV ligation (36.4 vs. 9.6%; <jats:italic>p<\/jats:italic>\u2009=\u20090.025) were found to be significant risk factors for late\u2010onset gastrointestinal hemorrhage. Among 11 patients who experienced late\u2010onset gastrointestinal hemorrhage, 7 had PV occlusion and 6 had local recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data suggested for the first time that both oncologic and non\u2010oncologic factors might contribute to late\u2010onset gastrointestinal hemorrhage after PD for pancreatic cancer. Furthermore, PV occlusion, no PV\u2013SPV patency, and SPV ligation were found to be significant risk factors for late\u2010onset gastrointestinal hemorrhage. Therefore, to prevent late\u2010onset gastrointestinal hemorrhage, we must consider various approaches to maintain the patency of the PV and SPV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4791-7","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T16:18:51Z","timestamp":1537201131000},"page":"626-633","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk Factors for Late\u2010Onset Gastrointestinal Hemorrhage After Pancreatoduodenectomy for Pancreatic Cancer"],"prefix":"10.1002","volume":"43","author":[{"given":"Minako","family":"Nagai","sequence":"first","affiliation":[{"name":"Department of Surgery Nara Medical University 840 Shijo\u2010cho 634\u20108522 Kashihara Nara Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Sho","sequence":"additional","affiliation":[{"name":"Department of Surgery Nara Medical University 840 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