Safety and efficacy of total mesopancreas excision with pancreaticoduodenectomy in treatment of periampullary carcinoma and pancreatic head carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Yunke , SU Song , GAN Yu , FANG Cheng , PENG Fangyi ,  LI Bo

Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

LI Bo, Email: liboer2002@126.com

Keywords：

pancreatic head carcinoma; periampullary carcinoma; mesopancreas; pancreaticoduodenectomy

DOI：

10.7507/1007-9424.201808037

Video：

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Objective To compare surgical safety and postoperative efficacy of total mesopancreas excision (TMpE) with pancreaticoduodenectomy (PD) and standard PD (Whipple).Methods A total of 123 patients underwent PD in the Affiliated Hospital of Southwest Medical University from August 2013 to December 2017 were included, including 47 patients with pancreatic head carcinoma and 76 patients with periampullary carcinoma, then were divided into a TMpE group and a Whipple group respectively. The operative time, intraoperative blood loss, postoperative hospitalization time, postoperative recovery time of gastrointestinal function, postoperative complications, and postoperative survival of patients with the same site between the Whipple group and the TMpE group were retrospectively compared.Results ① There were no significant differences in the baseline data between the TMpE group and the Whipple group in the pancreatic head carcinoma and periampullary carcinoma (P>0.05). ② For the patients with pancreatic head carcinoma, there were no significant differences in the operative time, postoperative hospitalization time, and postoperative gastrointestinal function recovery time between the TMpE group and the Whipple group (P>0.05), but the intraoperative blood loss in the TMpE group was significantly higher than that in the Whipple group (P=0.038); For the patients with periampullary carcinoma, the above indexes had no significant differences between the TMpE group and the Whipple group (P>0.05). ③ The total incidence of complications in the TMpE group was significantly higher than that in the Whipple group for the patients with pancreatic head carcinoma (χ²=6.595, P=0.010), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (P>0.05). ④ The cumulative survival curve in the TMpE group was better than that in the Whipple group for the patients with pancreatic head carcinoma (χ²=9.597, P=0.002), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (χ²=0.844, P=0.358).Conclusions For patients with pancreatic head cancer, comparing with standard Whipple, although TMpE PD increases intraoperative blood loss and overall incidence of complications, it could significantly improve long-term survival and there are no significant differences in postoperative recovery time and operative safety between Whipple and TMpE; For patients with periampullary carcinoma, there are no significant differences in surgical safety, long-term survival rate, and survival time between TMpE and Whipple.

Citation： XU Yunke, SU Song, GAN Yu, FANG Cheng, PENG Fangyi, LI Bo. Safety and efficacy of total mesopancreas excision with pancreaticoduodenectomy in treatment of periampullary carcinoma and pancreatic head carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1464-1468. doi: 10.7507/1007-9424.201808037 Copy

1.	趙玉沛. 胰腺癌診治現狀與展望. 中國普外基礎與臨床雜志, 2003, 10(3): 205-206.
2.	Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin, 2013, 63(1): 11-30.
3.	Goldstein D, Carroll S, Apte M, et al. Modern management of pancreatic carcinoma. Intern Med J, 2004, 34(8): 475-481.
4.	盧秋良, 林芳, 段浩清, 等. 胰十二指腸切除術治療胰腺癌的效果評價. 中國當代醫藥, 2014, 21(32): 46-47, 50.
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7.	馬炳奇, 張順, 張斌, 等. 胰十二指腸切除術后胰瘺發生的相關性因素分析. 中國普通外科雜志, 2013, 22(3): 315-319.
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11.	Kawabata Y, Tanaka T, Nishi T, et al. Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol, 2012, 38(7): 574-579.
12.	吳文廣, 吳向嵩, 李茂嵐, 等. 胰頭癌行胰腺全系膜切除75例報告. 中國實用外科雜志, 2013, 33(10): 859-862.
13.	劉仁民, 宗光全, 王峰, 等. 老年胰頭癌和壺腹周圍癌行胰十二指腸切除術的臨床效果. 肝膽胰外科雜志, 2016, 28(3): 181-184.
14.	葛春林, 郭克建. 胰腺癌可切除性的判斷. 中國普外基礎與臨床雜志, 2003, 10(6): 526-527.
15.	郭克建. 胰腺癌診斷方法的一些進展. 中國普外基礎與臨床雜志, 2002, 9(6): 369-370.
16.	范煒, 薛強, 陳圣開, 等. 保留幽門十二指腸胰頭切除術的臨床療效分析. 重慶醫學, 2015, 11(2): 226-228.
17.	趙玉沛, 戴夢華. 胰腺癌生物治療現狀與進展. 中國普外基礎與臨床雜志, 2002, 9(6): 371-373.
18.	刁同進, 趙曉東, 陳新, 等. 胰頭癌的外科手術綜合治療143例臨床分析. 肝膽胰外科雜志, 2013, 25(5): 376-380, 384.
19.	杜露, 徐新建, 耿城, 等. 聯合門靜脈/腸系膜上靜脈切除的胰十二指腸術治療胰頭癌的療效. 中國普通外科雜志, 2016, 25(3): 381-386.
20.	Strobel O, Hank T, Hinz U, et al. Pancreatic cancer surgery: The new R-status counts. Ann Surg, 2017, 265(3): 565-573.
21.	Rumstadt B, Schwab M, Korth P, et al. Hemorrhage after pancreatoduodenectomy. Ann Surg, 1998, 227(2): 236-241.
22.	Shaib Y, Davila J, Naumann C, et al. The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. Population-based study. Am J Gastroenterol, 2007, 102(7): 1377-1382.
23.	蔣奎榮, 蔡寶寶, 苗毅. 胰腺全系膜切除在胰頭癌行胰十二指腸切除術中的應用及意義. 肝膽外科雜志, 2014, 22(1): 12-14.
24.	Abrams RA, Lowy AM, O’Reilly EM, et al. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol, 2009, 16(7): 1751-1756.
25.	Liu XF, Tang K, Sun FB, et al. Partial resection of the pancreatic head and duodenum for management of carcinoma of the ampulla of Vater: a case report. Anticancer Res, 2016, 36(3): 1319-1324.

1. 趙玉沛. 胰腺癌診治現狀與展望. 中國普外基礎與臨床雜志, 2003, 10(3): 205-206.
2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin, 2013, 63(1): 11-30.
3. Goldstein D, Carroll S, Apte M, et al. Modern management of pancreatic carcinoma. Intern Med J, 2004, 34(8): 475-481.
4. 盧秋良, 林芳, 段浩清, 等. 胰十二指腸切除術治療胰腺癌的效果評價. 中國當代醫藥, 2014, 21(32): 46-47, 50.
5. 吳在德, 吳肇漢. 外科學. 第7版. 北京: 人民衛生出版社, 2008: 583-585.
6. 馬進, 陳江明, 潘樹波, 等. 胰頭癌擴大根治術與標準根治術對遠期生存影響的薈萃分析. 中華普通外科雜志, 2015, 30(7): 556-561.
7. 馬炳奇, 張順, 張斌, 等. 胰十二指腸切除術后胰瘺發生的相關性因素分析. 中國普通外科雜志, 2013, 22(3): 315-319.
8. Rau BM, Moritz K, Schuschan S, et al. R1 resection in pancreatic cancer has significant impact on long-term outcome in standardized pathology modified for routine use. Surgery, 2012, 152(3 Suppl 1): S103-S111.
9. Weitz J, Rahbari N, Koch M, et al. The " artery first” approach for resection of pancreatic head cancer. J Am Coll Surg, 2010, 210(2): e1-e4.
10. Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol, 2012, 38(4): 340-345.
11. Kawabata Y, Tanaka T, Nishi T, et al. Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol, 2012, 38(7): 574-579.
12. 吳文廣, 吳向嵩, 李茂嵐, 等. 胰頭癌行胰腺全系膜切除75例報告. 中國實用外科雜志, 2013, 33(10): 859-862.
13. 劉仁民, 宗光全, 王峰, 等. 老年胰頭癌和壺腹周圍癌行胰十二指腸切除術的臨床效果. 肝膽胰外科雜志, 2016, 28(3): 181-184.
14. 葛春林, 郭克建. 胰腺癌可切除性的判斷. 中國普外基礎與臨床雜志, 2003, 10(6): 526-527.
15. 郭克建. 胰腺癌診斷方法的一些進展. 中國普外基礎與臨床雜志, 2002, 9(6): 369-370.
16. 范煒, 薛強, 陳圣開, 等. 保留幽門十二指腸胰頭切除術的臨床療效分析. 重慶醫學, 2015, 11(2): 226-228.
17. 趙玉沛, 戴夢華. 胰腺癌生物治療現狀與進展. 中國普外基礎與臨床雜志, 2002, 9(6): 371-373.
18. 刁同進, 趙曉東, 陳新, 等. 胰頭癌的外科手術綜合治療143例臨床分析. 肝膽胰外科雜志, 2013, 25(5): 376-380, 384.
19. 杜露, 徐新建, 耿城, 等. 聯合門靜脈/腸系膜上靜脈切除的胰十二指腸術治療胰頭癌的療效. 中國普通外科雜志, 2016, 25(3): 381-386.
20. Strobel O, Hank T, Hinz U, et al. Pancreatic cancer surgery: The new R-status counts. Ann Surg, 2017, 265(3): 565-573.
21. Rumstadt B, Schwab M, Korth P, et al. Hemorrhage after pancreatoduodenectomy. Ann Surg, 1998, 227(2): 236-241.
22. Shaib Y, Davila J, Naumann C, et al. The impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. Population-based study. Am J Gastroenterol, 2007, 102(7): 1377-1382.
23. 蔣奎榮, 蔡寶寶, 苗毅. 胰腺全系膜切除在胰頭癌行胰十二指腸切除術中的應用及意義. 肝膽外科雜志, 2014, 22(1): 12-14.
24. Abrams RA, Lowy AM, O’Reilly EM, et al. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol, 2009, 16(7): 1751-1756.
25. Liu XF, Tang K, Sun FB, et al. Partial resection of the pancreatic head and duodenum for management of carcinoma of the ampulla of Vater: a case report. Anticancer Res, 2016, 36(3): 1319-1324.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety and efficacy of total mesopancreas excision with pancreaticoduodenectomy in treatment of periampullary carcinoma and pancreatic head carcinoma

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