Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma

Abstract Background The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival...

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Bibliographic Details
Published in:European journal of surgical oncology 2012-07, Vol.38 (7), p.574-579
Main Authors: Kawabata, Y, Tanaka, T, Nishi, T, Monma, H, Yano, S, Tajima, Y
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angiography - instrumentation
Carcinoma - blood supply
Carcinoma - mortality
Carcinoma - pathology
Carcinoma - surgery
Female
First jejunal artery
Hematology, Oncology and Palliative Medicine
Humans
Inferior pancreaticoduodenal artery
Lymph Node Excision
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Male
Mesenteric Artery, Superior - diagnostic imaging
Mesenteric Artery, Superior - surgery
Meso-pancreatoduodenum
Middle Aged
Neoplasm Staging
Pancreatic head carcinoma
Pancreatic Neoplasms - blood supply
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - methods
Pancreaticoduodenectomy - mortality
Superior mesenteric artery
Surgery
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Abstract Background The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the “meso-pancreatoduodenum.” which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery. Methods A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD. Results The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5–40) in the sPD and 26 (median, range: 13–50) in the tMPDe ( p  = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) ( p  = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients. Conclusion Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2012.04.007