Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Hongxiang , XU Jie , WANG Jiaguo , YOU Ke ,  LIU Zuojin

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, P. R. China;

Corresponding?author：

LIU Zuojin, Email: 300376@hospital.cqmu.edu.cn

Keywords：

laparoscopic pancreaticoduodenectomy; posterior approach; uncinate-process-first

DOI：

10.7507/1007-9424.202309032

Video：

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Objective To explore the safety and feasibility of the uncinate-process-first superior mesenteric artery (SMA) right posterior approach in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of 5 patients admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2022 to May 2023 were retrospectively analyzed, all patients underwent uncinate-process-first SMA right posterior approach during LPD. Results All 5 cases of LPD with uncinate-process-first SMA right posterior approach were successfully completed. The operative time was (366±51) min, the intraoperative blood loss was (140±42) mL, and the postoperative hospital stay was (11±2) days. All the postoperative pathological findings reached R0 resection. None of the 5 patients suffered from biliary leakage, bleeding, or gastrointestinal empties, and 2 patients suffered from biochemical fistula, the postoperative follow-up time was (7±2) months, and there was no recurrence during the follow-up period. Conclusion The uncinate-process-first SMA right posterior approach is a safe and feasible surgical approach, especially for tumors with no obvious vascular invasion and diameter ≤2 cm.

Citation： WANG Hongxiang, XU Jie, WANG Jiaguo, YOU Ke, LIU Zuojin. Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1289-1293. doi: 10.7507/1007-9424.202309032 Copy

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2.	中華醫學會外科學分會胰腺外科學組. 中國胰腺癌診治指南 (2021). 中國實用外科雜志, 2021, 41(7): 725-738.
3.	Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
4.	牛河源, 孟興凱. 基于胰腺系膜解剖探討胰十二指腸切除術手術入路的選擇. 肝膽胰外科雜志, 2022, 34(11): 696-699, 705.
5.	梁贇, 王巍. 腹腔鏡胰十二指腸切除術手術入路的選擇. 中國普外基礎與臨床雜志, 2021, 28(9): 1125-1128.
6.	Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7.	王小明, 孫衛東, 胡明華, 等. 右后下入路動脈先行的腹腔鏡胰十二指腸切除術. 中華胃腸外科雜志, 2016, 19(1): 71-74.
8.	高文濤, 奚春華, 涂敏, 等. 腹腔鏡下Treitz韌帶途徑鉤突優先、動脈優先入路胰十二指腸切除術的臨床應用. 中華外科雜志, 2017, 55(5): 359-363.
9.	Morales E, Zimmitti G, Codignola C, et al. Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy. Surg Endosc, 2019, 33(12): 4186-4191.
10.	王巍, 姜翀弋, 陳寅濤, 等. 腹腔鏡胰十二指腸切除術鉤突部位動脈解剖研究. 中國實用外科雜志, 2016, 36(2): 206-209,213.
11.	梁贇, 王巍, 姜翀弋, 等. 動脈優先入路處理胰腺鉤突在腹腔鏡胰十二指腸切除術中的應用. 中華肝臟外科手術學電子雜志, 2017, 6(1): 19-23.
12.	Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961. doi: 10.1038/s41598-019-49455-9.
13.	Nickel F, Haney CM, Kowalewski KF, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg, 2020, 271(1): 54-66.
14.	楊帆, 劉亞輝, 劉松陽, 等. 完全腹腔鏡“下入路, 鉤突優先, 動脈先行”胰十二指腸切除術的臨床應用. 中國微創外科雜志, 2018, 18(10): 908-910.
15.	黃孝倫, 鄒海波, 賴春友, 等. 海德堡三角清掃胰十二指腸切除術治療胰頭癌的臨床療效. 中華消化外科雜志, 2022, 21(4): 500-506.
16.	Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
17.	程智猛, 程南生, 熊先澤, 等. 胰十二指腸切除術后胃癱的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(8): 1018-1023.
18.	Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
19.	蔡鳳軍, 王曉棟, 楊永生. 胰腺癌行胰十二指腸切除術中淋巴結清掃的爭議與思考. 肝膽胰外科雜志, 2023, 35(8): 449-453, 458.
20.	Okano K, Hirao T, Unno M, et al. Postoperative infectious complications after pancreatic resection. Br J Surg, 2015, 102(12): 1551-1560.
21.	Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22.	Sugiura T, Mizuno T, Okamura Y, et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg, 2015, 102(12): 1561-1566.
23.	譚志健, 沈展濤, 劉一峰, 等. No-touch技術在胰頭癌腹腔鏡胰十二指腸切除術中的初步效果. 中華肝膽外科雜志, 2020, 26(8): 569-572.
24.	陳慶民, 劉松陽, 王英超, 等. “結腸后入路-鉤突先行”在腹腔鏡胰十二指腸切除術中應用研究. 中國實用外科雜志, 2019, 39(12): 1321-1325.
25.	肖杰, 周濤, 孫占虎, 等. 動脈入路胰腺全系膜切除胰十二指腸切除術治療胰頭癌的臨床效果觀察. 臨床誤診誤治, 2022, 35(7): 64-67.

1. Chiorean EG, Chiaro MD, Tempero MA, et al. Ampullary Adenocarcinoma, Version 1. 2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2023, 21(7): 753-782.
2. 中華醫學會外科學分會胰腺外科學組. 中國胰腺癌診治指南 (2021). 中國實用外科雜志, 2021, 41(7): 725-738.
3. Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
4. 牛河源, 孟興凱. 基于胰腺系膜解剖探討胰十二指腸切除術手術入路的選擇. 肝膽胰外科雜志, 2022, 34(11): 696-699, 705.
5. 梁贇, 王巍. 腹腔鏡胰十二指腸切除術手術入路的選擇. 中國普外基礎與臨床雜志, 2021, 28(9): 1125-1128.
6. Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7. 王小明, 孫衛東, 胡明華, 等. 右后下入路動脈先行的腹腔鏡胰十二指腸切除術. 中華胃腸外科雜志, 2016, 19(1): 71-74.
8. 高文濤, 奚春華, 涂敏, 等. 腹腔鏡下Treitz韌帶途徑鉤突優先、動脈優先入路胰十二指腸切除術的臨床應用. 中華外科雜志, 2017, 55(5): 359-363.
9. Morales E, Zimmitti G, Codignola C, et al. Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy. Surg Endosc, 2019, 33(12): 4186-4191.
10. 王巍, 姜翀弋, 陳寅濤, 等. 腹腔鏡胰十二指腸切除術鉤突部位動脈解剖研究. 中國實用外科雜志, 2016, 36(2): 206-209,213.
11. 梁贇, 王巍, 姜翀弋, 等. 動脈優先入路處理胰腺鉤突在腹腔鏡胰十二指腸切除術中的應用. 中華肝臟外科手術學電子雜志, 2017, 6(1): 19-23.
12. Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961. doi: 10.1038/s41598-019-49455-9.
13. Nickel F, Haney CM, Kowalewski KF, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg, 2020, 271(1): 54-66.
14. 楊帆, 劉亞輝, 劉松陽, 等. 完全腹腔鏡“下入路, 鉤突優先, 動脈先行”胰十二指腸切除術的臨床應用. 中國微創外科雜志, 2018, 18(10): 908-910.
15. 黃孝倫, 鄒海波, 賴春友, 等. 海德堡三角清掃胰十二指腸切除術治療胰頭癌的臨床療效. 中華消化外科雜志, 2022, 21(4): 500-506.
16. Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
17. 程智猛, 程南生, 熊先澤, 等. 胰十二指腸切除術后胃癱的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(8): 1018-1023.
18. Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
19. 蔡鳳軍, 王曉棟, 楊永生. 胰腺癌行胰十二指腸切除術中淋巴結清掃的爭議與思考. 肝膽胰外科雜志, 2023, 35(8): 449-453, 458.
20. Okano K, Hirao T, Unno M, et al. Postoperative infectious complications after pancreatic resection. Br J Surg, 2015, 102(12): 1551-1560.
21. Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22. Sugiura T, Mizuno T, Okamura Y, et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg, 2015, 102(12): 1561-1566.
23. 譚志健, 沈展濤, 劉一峰, 等. No-touch技術在胰頭癌腹腔鏡胰十二指腸切除術中的初步效果. 中華肝膽外科雜志, 2020, 26(8): 569-572.
24. 陳慶民, 劉松陽, 王英超, 等. “結腸后入路-鉤突先行”在腹腔鏡胰十二指腸切除術中應用研究. 中國實用外科雜志, 2019, 39(12): 1321-1325.
25. 肖杰, 周濤, 孫占虎, 等. 動脈入路胰腺全系膜切除胰十二指腸切除術治療胰頭癌的臨床效果觀察. 臨床誤診誤治, 2022, 35(7): 64-67.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy

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