Extended pancreaticoduodenetomy combined with mesentery root resection in treatment of patients with pancreatic and duodenal malignancy involving root of mesentery
- Author:
Yi-Jie ZHANG
1
Author Information
1. Department of General Surgery
- Publication Type:Journal Article
- Keywords:
Adenocarcinoma;
Duodenal neoplasms;
Mesentery root;
Pancreas neoplasms;
Pancreatico-dudenectomy;
Survival rate
- From:
Academic Journal of Second Military Medical University
2010;28(8):867-870
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To search for a method for radical resection of pancreatic and duodena malignancy involving the mesentery root and for the long post-operation survival of patients. Methods: From Jan. 2004 to Aug. 2006, a total of 26 (16 male and 10 female, aged 27-70) patients with pancreatic and duodenal malignancy involving the mesentery root were treated in our department. The patients included 3 with duodenal malignancy and 23 with pancreatic malignancy. Curative resection was performed by the extended pancreaticoduodenetomy (Whipple procedure) combined with mesentery root resection (MRR) for all patients. The outcomes, safety and the post-operation survival rate were analyzed retrospectively. Results: Thirteen patients were treated with Whipple procedures combined with MRR, 9 were treated with partial portal vein/superior mesenteric vein (PV/SMV) and reconstruction of the vessel, and 4 patients received pre-shunt between PV and SMV with artificial vessel graft before the extended Whipple and NMR procedures. The operation time was 2. 5 to 7 (4. 4 ± 1. 1) hour 9 and blood loss was 300 to 5 000 (1 892 ± 1 414) ml with the blood transfusion of 0 to 5 600 (2 100 ± 1 586) ml. There was no death in our group and 7 (27%) had post-operation complication. The post-operation hospital stay was 10 to 30 days. The pathologic examination showed negative surgical margins for all specimens. The tumor size was 4 to 10 (6.17 ± 2.03) cm. After a follow-up of 9 to 38 months, the pain was relieved in all patients. One of the 3 patients with duodenal adenocarcinoma had liver metastasis at 10 months after operation, and the other 2 survived 10 months and 27 months without evidence of tumor reccurence. The patient with pancreatic micro-adenocarcinoma died of local reccurence 9 months after operation. The patient with neuroendocrine carcinoma died of organ failure 24 months after operation. The patient with lymphoma have survived for 24 months after operation. The 1-year and 2-year accumulated survival rates in the 20 cases with pancreatic ductal cancer were 86.6% and 45.6%, respectively. Conclusion: The extended Whipple procedure with MRR is safe and effective. It can obtain RO resection in patients with malignant tumors (over 5 cm in diameter) in the head, neck and uncinate process of the pancreas and duodenal.
