Isolation of superior mesenteric artery and resection of mesentery root is beneficial for radical pancreaticoduodenectomy in the treatment of pancreatic ductal adenocarcinoma
- VernacularTitle:游离肠系膜上动脉对提高胰腺钩突癌切除彻底性的临床意义
- Author:
Yijie ZHANG
;
Xiangui HU
;
Gang JIN
;
Tianlin HE
;
Chenghao SHAO
;
Gang LI
;
Wei JING
;
Bin SONG
- Publication Type:Journal Article
- Keywords:
Pancreatic neoplasms;
Pancreaticoduodenectomy;
Mesenteric artery,superior
- From:
Chinese Journal of Pancreatology
2008;08(6):353-356
- CountryChina
- Language:Chinese
-
Abstract:
Objective To improve the prognosis and radical resection of the extended pancreaticoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery mot. Methods From Jan. 2004 to Dec. 2007, a total of 23 ( 14 male and 9 female, aged between 30 and 72 years old) patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery (SMA) isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was (4.2 ± 1.1 ) hours, and the blood loss was ( 1 635 ± 1 362) ml with the blood transfusion of ( 1 609 ± 1 462 ) ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The post-operative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was (5.3 ± 1.4) cm. 13 patients (57%) had one or more lymph nodes metastasis. 20 patients (87%) had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22 patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Radical operation resection could be achieved in the treatment of pancreatic cancer in uncinate process.
