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"Total arterial devascularization first" technique for resection of pancreatic head cancer during pancreaticoduodenectomy.

Abstract

Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first" (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5-8.1 h). The median intraoperative blood loss was 450 mL (ranging 200-900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.

Authors+Show Affiliations

Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Colon Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.Department of General Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. ryqin@tjh.tjmu.edu.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24142721

Citation

Peng, Feng, et al. ""Total Arterial Devascularization First" Technique for Resection of Pancreatic Head Cancer During Pancreaticoduodenectomy." Journal of Huazhong University of Science and Technology. Medical Sciences = Hua Zhong Ke Ji Da Xue Xue Bao. Yi Xue Ying De Wen Ban = Huazhong Keji Daxue Xuebao. Yixue Yingdewen Ban, vol. 33, no. 5, 2013, pp. 687-691.
Peng F, Wang M, Zhu F, et al. "Total arterial devascularization first" technique for resection of pancreatic head cancer during pancreaticoduodenectomy. J Huazhong Univ Sci Technol Med Sci. 2013;33(5):687-691.
Peng, F., Wang, M., Zhu, F., Tian, R., Shi, C. J., Xu, M., ... Qin, R. Y. (2013). "Total arterial devascularization first" technique for resection of pancreatic head cancer during pancreaticoduodenectomy. Journal of Huazhong University of Science and Technology. Medical Sciences = Hua Zhong Ke Ji Da Xue Xue Bao. Yi Xue Ying De Wen Ban = Huazhong Keji Daxue Xuebao. Yixue Yingdewen Ban, 33(5), pp. 687-691. doi:10.1007/s11596-013-1181-0.
Peng F, et al. "Total Arterial Devascularization First" Technique for Resection of Pancreatic Head Cancer During Pancreaticoduodenectomy. J Huazhong Univ Sci Technol Med Sci. 2013;33(5):687-691. PubMed PMID: 24142721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Total arterial devascularization first" technique for resection of pancreatic head cancer during pancreaticoduodenectomy. AU - Peng,Feng, AU - Wang,Min, AU - Zhu,Feng, AU - Tian,Rui, AU - Shi,Cheng-Jian, AU - Xu,Meng, AU - Wang,Xin, AU - Shen,Ming, AU - Hu,Jun, AU - Peng,Shu-You, AU - Qin,Ren-Yi, Y1 - 2013/10/20/ PY - 2013/07/05/received PY - 2013/09/12/revised PY - 2013/10/22/entrez PY - 2013/10/22/pubmed PY - 2014/10/31/medline SP - 687 EP - 691 JF - Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban JO - J. Huazhong Univ. Sci. Technol. Med. Sci. VL - 33 IS - 5 N2 - Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first" (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5-8.1 h). The median intraoperative blood loss was 450 mL (ranging 200-900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD. SN - 1672-0733 UR - https://www.unboundmedicine.com/medline/citation/24142721/"Total_arterial_devascularization_first"_technique_for_resection_of_pancreatic_head_cancer_during_pancreaticoduodenectomy L2 - https://doi.org/10.1007/s11596-013-1181-0 DB - PRIME DP - Unbound Medicine ER -