The clinical value of radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer
10.3760/cma.j.cn112139-20230504-00191
- VernacularTitle:腹膜后淋巴脂肪板层根治性切除术在可切除性胰头癌治疗中的临床价值再探讨
- Author:
Shuyou PENG
1
;
Yingbin LIU
;
Renyi QIN
;
Defei HONG
;
Jiangtao LI
;
Zhijian TAN
;
Yuanquan YU
;
Xiaosheng ZHONG
;
Min WANG
;
Xu′an WANG
Author Information
1. 浙江大学医学院附属第二医院肝胆胰外科，杭州 310006
- Keywords:
Pancreatic neoplasms;
Pancreaticoduodenectomy;
Retroperitoneal lipo-lymphatic layer;
Lymph node dissection
- From:
Chinese Journal of Surgery
2023;61(11):989-993
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer.Methods:Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test, Z test,or χ 2 test, respectively. Results:Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group ( Z=-10.691, P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion:The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.
