Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Pancreaticoduodenectomy with superior mesenteric artery first-approach combined total meso-pancreas excision for periampullary malignancies: A high-volume single-center experience with short-term outcomes

  • Thanh Khiem Nguyen (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Ham Hoi Nguyen (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Tuan Hiep Luong (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Kim Khue Dang (VinUniversity) ;
  • Van Duy Le (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Duc Dung Tran (Department of Surgery, Thai Binh Medical University) ;
  • Van Minh Do (Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital) ;
  • Hong Quang Pham (Department of Surgery, Thai Binh Medical University) ;
  • Hoan My Pham (VinUniversity) ;
  • Thi Lan Tran (Pathology Center, Bach Mai Hospital) ;
  • Cuong Thinh Nguyen (108 Institute of Clinical Medical and Pharmaceutical Sciences) ;
  • Hong Son Trinh (Department of Oncology, Viet Duc University Hospital) ;
  • Yosuke Inoue (Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research)
  • Received : 2023.06.02
  • Accepted : 2023.07.26
  • Published : 2024.02.29
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Abstract

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results. There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape. Methods: We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated. Results: The median operative time was 289.6 min (178-540 min), the median intraoperative blood loss was 209 mL (30-1,600 mL). Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%. Conclusions: The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.

Keywords

Acknowledgement

The authors wish to thank to all the colleagues of the Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam for their assistance during the time of our patients' in-hospital observation.

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