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Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach.
Surg Endosc. 2018 10; 32(10):4209-4215.SE

Abstract

BACKGROUND

The en bloc resection of the superior mesenteric or portal vein with concomitant venous reconstruction may be required in patients with borderline resectable pancreatic cancer. However, performing laparoscopic pancreaticoduodenectomy (LPD) with major venous resection and reconstruction is technically challenging. Herein, we introduced a safe and feasible technique to perform LPD with major venous resection.

METHODS

Over the period of November 2015 to November 2016, 18 patients underwent laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction using the anterior superior mesenteric artery (SMA)-first approach at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected.

RESULTS

Eighteen male and ten female patients were included in this study. The median age of the patients was 58 years (range 49-76 years). Eight cases of wage resections, six cases of end-to-end anastomosis, and four cases of artificial grafts were performed in our series. Only one patient (5.6%) required conversion because of uncontrolled bleeding from the splenic vein. The average operative time was 448 min (range 420-570 min). The mean time for blood occlusion was 32 min, including 17 min for wage resections, 28 min for end-to-end anastomosis, and 48 min for artificial grafts. Thirty-day mortality was not observed in our series. The median postoperative hospital stay was 13 days (range 9-18 days). Three patients suffered from pancreatic fistula (Grade A), and one suffered from abdominal bleeding after subcutaneous injection with low-molecular heparin. In this case, abdominal bleeding was stopped through conservative therapies.

CONCLUSION

Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction can be safely and feasibly performed. The anterior SMA-first approach can facilitate this procedure and decrease operative time and blood occlusion duration.

Authors+Show Affiliations

Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China. Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China.Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China.Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China.Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China. liu745588@163.com.

Pub Type(s)

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

Language

eng

PubMed ID

29602996

Citation

Cai, Yunqiang, et al. "Laparoscopic Pancreaticoduodenectomy With Major Venous Resection and Reconstruction: Anterior Superior Mesenteric Artery First Approach." Surgical Endoscopy, vol. 32, no. 10, 2018, pp. 4209-4215.
Cai Y, Gao P, Li Y, et al. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc. 2018;32(10):4209-4215.
Cai, Y., Gao, P., Li, Y., Wang, X., & Peng, B. (2018). Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surgical Endoscopy, 32(10), 4209-4215. https://doi.org/10.1007/s00464-018-6167-3
Cai Y, et al. Laparoscopic Pancreaticoduodenectomy With Major Venous Resection and Reconstruction: Anterior Superior Mesenteric Artery First Approach. Surg Endosc. 2018;32(10):4209-4215. PubMed PMID: 29602996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. AU - Cai,Yunqiang, AU - Gao,Pan, AU - Li,Yongbin, AU - Wang,Xin, AU - Peng,Bing, Y1 - 2018/03/30/ PY - 2017/11/02/received PY - 2018/03/21/accepted PY - 2018/4/1/pubmed PY - 2019/11/5/medline PY - 2018/4/1/entrez KW - Laparoscopic KW - Minimal invasive surgery KW - Pancreatectomy KW - Pancreaticoduodenectomy KW - Vascular resection SP - 4209 EP - 4215 JF - Surgical endoscopy JO - Surg Endosc VL - 32 IS - 10 N2 - BACKGROUND: The en bloc resection of the superior mesenteric or portal vein with concomitant venous reconstruction may be required in patients with borderline resectable pancreatic cancer. However, performing laparoscopic pancreaticoduodenectomy (LPD) with major venous resection and reconstruction is technically challenging. Herein, we introduced a safe and feasible technique to perform LPD with major venous resection. METHODS: Over the period of November 2015 to November 2016, 18 patients underwent laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction using the anterior superior mesenteric artery (SMA)-first approach at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected. RESULTS: Eighteen male and ten female patients were included in this study. The median age of the patients was 58 years (range 49-76 years). Eight cases of wage resections, six cases of end-to-end anastomosis, and four cases of artificial grafts were performed in our series. Only one patient (5.6%) required conversion because of uncontrolled bleeding from the splenic vein. The average operative time was 448 min (range 420-570 min). The mean time for blood occlusion was 32 min, including 17 min for wage resections, 28 min for end-to-end anastomosis, and 48 min for artificial grafts. Thirty-day mortality was not observed in our series. The median postoperative hospital stay was 13 days (range 9-18 days). Three patients suffered from pancreatic fistula (Grade A), and one suffered from abdominal bleeding after subcutaneous injection with low-molecular heparin. In this case, abdominal bleeding was stopped through conservative therapies. CONCLUSION: Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction can be safely and feasibly performed. The anterior SMA-first approach can facilitate this procedure and decrease operative time and blood occlusion duration. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/29602996/Laparoscopic_pancreaticoduodenectomy_with_major_venous_resection_and_reconstruction:_anterior_superior_mesenteric_artery_first_approach_ L2 - https://dx.doi.org/10.1007/s00464-018-6167-3 DB - PRIME DP - Unbound Medicine ER -