Laparoscopic subtotal pancreatectomy with radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer
Laparoscopic subtotal pancreatectomy with radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer
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DOI：
10.1016/j.suronc.2018.12.006
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发表时间：
2019-03-01
影响因子：
2.3
通讯作者：
Cho, Jai Young
中科院分区：
文献类型：
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作者：
Kim, Seongho;Yoon, Yoo-Seok;Cho, Jai Young
背景资料：最近的许多研究报告了腹腔镜远端胰腺切除术治疗胰腺癌的肿瘤学结局与开放手术相当[1，2]。然而，大多数腹腔镜手术涉及左侧胰腺癌切除术，其中通过门静脉-肠系膜上静脉周围的胰腺横切并保留胃十二指肠动脉（GDA）可以进行R 0切除[3，4]。在这里，我们描述了我们的腹腔镜胰腺次全切除术的技术位于胰腺颈部的胰腺癌，这需要切除GDA和根治性顺行模块化胰脾切除术（RAMPS），以实现一个明确的切除margin.Video：胰腺肿块被发现在一个72岁的女性在例行健康检查。腹部电脑断层显示一个直径2公分的低密度肿块，位于胰脏颈部，靠近GDA。我们计划进行腹腔镜胰腺次全切除术，切除GDA。GDA切除后，在十二指肠附近进行胰腺次全切除术。解剖腹腔轴和上级肠系膜动脉左侧的淋巴结。结果：手术时间220 min，术中出血量200 mL。所有切除边缘均清晰。病理分期为pT 3 N 0，共取出21个淋巴结。患者于术后第7天出院，无术后并发症。结论：根治性切除左侧胰腺癌可以安全地进行腹腔镜胰腺次全切除术与RAMPS。
Background: Numerous recent studies have reported comparable oncologic outcomes of laparoscopic distal pancreatectomy for pancreatic cancer compared with open surgery [1,2]. Most of these laparoscopic procedures, however, involved resection for left-sided pancreatic cancer where R0 resection was possible by pancreatic transection around the portal vein-superior mesenteric vein with preservation of the gastroduodenal artery (GDA) [3,4]. Here we describe our technique of laparoscopic subtotal pancreatectomy for pancreatic cancer located in the neck of the pancreas, which requires resection of the GDA and radical antegrade modular pancreatosplenectomy (RAMPS) to achieve a clear resection margin.Video: A pancreatic mass was detected in a 72-year-old female at a routine health check. Abdominal CT revealed a low-attenuating mass of diameter 2 cm located in the neck of the pancreas, close to the GDA. We planned laparoscopic subtotal pancreatectomy with resection of the GDA. Subtotal pancreatectomy near the duodenum was performed after resection of the GDA. Lymph nodes on the left side of the celiac axis and superior mesenteric artery were dissected. Retroperitoneal dissection was performed by anterior RAMPS, exposing the left renal vein and saving the left adrenal gland.Results: The operative time was 220 minutes and the estimated intraoperative blood loss was 200 mL. All the resection margins were clear. The pathologic staging was pT3N0, and 21 lymph nodes were retrieved. The patient was discharged on postoperative day 7 with no postoperative complications.Conclusion: Curative resection of left-sided pancreatic cancer can be safely performed by laparoscopic subtotal pancreatectomy with RAMPS.