Pancreatic surgery in Nagoya University
- VernacularTitle:Нагояа их сургуулийн нойр булчирхайн мэс заслын өнөөгийн байдал
- Author:
Tsutomu Fujii, MD, PhD, FACS
- Publication Type:journal article
- From:Innovation
2014;8(4):134-135
- CountryMongolia
- Language:English
-
Abstract:
Background: Nagoya University is one of the high-volume centers of pancreatic
surgery in Japan. We experienced about 800 pancreatectomies between 2000
and 2013. Furthermore, we have reported many papers which have contributed
to development of pancreatic surgery. The following are procedures that have
reported its usefulness from our department.
1. Mesenteric approach in surgery for pancreatic cancer
Akimasa Nakao, our previous professor, developed ‘the mesenteric approach’
procedure in 1993, which was mentioned by subsequent authors as the ‘arteryfirst
approach’. This procedure facilitates radical lymph node dissection around
both the superior mesenteric artery and the portal vein (PV), and can reduce
tension of a direct end-to-end anastomosis of PV, compared with conventional
approaches.
2. Portal vein resection and Anthron catherter bypass
Professor Nakao developed an antithrombogenic bypass catheter of the portal
vein. With this catheter, mesenteric venous blood can be bypassed to the systemic
circulation or intrahepatic portal vein to prevent portal congestion or hepatic
ischemia during portal obstruction or simultaneous obstruction of the hepatic
artery. This catheter was useful in cases of hepatobiliary and pancreatic cancer
surgery combined with portal vein resection.
3. Modified Blumgart anastomosis (Nagoya method) for pancreatojejunostomy
Recently, we established a simplified version of the Blumgart anastomosis
technique, and reported as the modified Blumgart anastomosis. Placement of
sutures between the pancreatic parenchyma and the jejunum risks leakage of
pancreatic juice from the needle holes or laceration of the pancreatic parenchyma,
especially in patients with soft pancreas. The original Blumgart anastomosis used
four to six transpancreatic/ jejunal seromuscular sutures, and our method used
only one to three. Our method also completely covered the pancreatic stump with
jejunal serosa because of the modified lateral suture through the seromuscular
layer of the jejunum. These modifications resulted in more favorable outcomes.
4. Subtotal stomach-preserving pancreatoduodenectomy (SSPPD)
We reported the usefulness of SSPPD in terms of the perioperative outcomes
and long-term nutritional consequences. We compared three PDs (conventional
pancreatoduodenectomy with a distal gastrectomy (cPD), pylorus-preserving
pancreatoduodenectomy (PPPD), and SSPPD), and found that the incidence
of delayed gastric emptying was significantly higher in the PPPD group than
in the cPD and SSPPD groups (27.3%, 5.8%, and 5.4%). The serum albumin
concentration and total lymphocyte count at 1 year postoperatively were
significantly higher in the SSPPD group than in the PPPD group. We believe that
preservation of the pyloric ring without vagal innervation has little significance,
and that SSPPD with better perioperative and long-term outcomes is more suitable
as a standard procedure for patients with pancreatic head cancer.
