Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma
Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma
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DOI：
10.1016/j.ejso.2012.04.007
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发表时间：
2012-07-01
期刊：
影响因子：
3.8
通讯作者：
Tajima, Y.
中科院分区：
文献类型：
--
作者：
Kawabata, Y.;Tanaka, T.;Tajima, Y.
背景：胰头癌（PHC）行胰十二指肠切除术（PD）最重要的预后因素是切除边缘和淋巴结状况。根治性手术切缘（R0）和区域淋巴结的完全清除有助于提高生存率。为了减少显微残留肿瘤切除（R1），并在PHC行PD时实现肠系膜上动脉（SMA）周围的完全淋巴结切除术，我们提出了全切除“中胰十二指肠”的新概念，其中包括沿胰十二指肠下动脉和第一空肠动脉的一簇软结缔组织。方法：2006年5月至2011年8月期间，共有39例连续在岛根大学医院因PHC接受PD治疗的患者。25例患者接受了标准PD (sPD)， 14例患者接受了PD的全中胰十二指肠切除术（tMPDe）。结果：tMPDe手术安全，无术中并发症。sPD组清扫淋巴结总数为18个（中位数，范围5-40），tMPDe组清扫淋巴结总数为26个（中位数，范围13-50）（p = 0.027）。60%的sPD和93%的tMPDe患者分别完成了R0切除术，导致tMPDe的R1率（7%）显著低于sPD (40%) （p = 0.019）。tMPDe患者在SMA周围未发现局部区域复发。结论：我们的tMPDe手术技术在PD手术中是安全且更根治性的，作为胰头癌的病理治疗，在胰手术中应采用tMPDe技术。(c) 2012 Elsevier Ltd.版权所有。
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. (c) 2012 Elsevier Ltd. All rights reserved.