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.	赵玉沛. 胰腺癌诊治现状与展望. 中国普外基础与临床杂志, 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.	卢秋良, 林芳, 段浩清, 等. 胰十二指肠切除术治疗胰腺癌的效果评价. 中国当代医药, 2014, 21(32): 46-47, 50.
5.	吴在德, 吴肇汉. 外科学. 第7版. 北京: 人民卫生出版社, 2008: 583-585.
6.	马进, 陈江明, 潘树波, 等. 胰头癌扩大根治术与标准根治术对远期生存影响的荟萃分析. 中华普通外科杂志, 2015, 30(7): 556-561.
7.	马炳奇, 张顺, 张斌, 等. 胰十二指肠切除术后胰瘘发生的相关性因素分析. 中国普通外科杂志, 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.	吴文广, 吴向嵩, 李茂岚, 等. 胰头癌行胰腺全系膜切除75例报告. 中国实用外科杂志, 2013, 33(10): 859-862.
13.	刘仁民, 宗光全, 王峰, 等. 老年胰头癌和壶腹周围癌行胰十二指肠切除术的临床效果. 肝胆胰外科杂志, 2016, 28(3): 181-184.
14.	葛春林, 郭克建. 胰腺癌可切除性的判断. 中国普外基础与临床杂志, 2003, 10(6): 526-527.
15.	郭克建. 胰腺癌诊断方法的一些进展. 中国普外基础与临床杂志, 2002, 9(6): 369-370.
16.	范炜, 薛强, 陈圣开, 等. 保留幽门十二指肠胰头切除术的临床疗效分析. 重庆医学, 2015, 11(2): 226-228.
17.	赵玉沛, 戴梦华. 胰腺癌生物治疗现状与进展. 中国普外基础与临床杂志, 2002, 9(6): 371-373.
18.	刁同进, 赵晓东, 陈新, 等. 胰头癌的外科手术综合治疗143例临床分析. 肝胆胰外科杂志, 2013, 25(5): 376-380, 384.
19.	杜露, 徐新建, 耿城, 等. 联合门静脉/肠系膜上静脉切除的胰十二指肠术治疗胰头癌的疗效. 中国普通外科杂志, 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.	蒋奎荣, 蔡宝宝, 苗毅. 胰腺全系膜切除在胰头癌行胰十二指肠切除术中的应用及意义. 肝胆外科杂志, 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. 赵玉沛. 胰腺癌诊治现状与展望. 中国普外基础与临床杂志, 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. 卢秋良, 林芳, 段浩清, 等. 胰十二指肠切除术治疗胰腺癌的效果评价. 中国当代医药, 2014, 21(32): 46-47, 50.
5. 吴在德, 吴肇汉. 外科学. 第7版. 北京: 人民卫生出版社, 2008: 583-585.
6. 马进, 陈江明, 潘树波, 等. 胰头癌扩大根治术与标准根治术对远期生存影响的荟萃分析. 中华普通外科杂志, 2015, 30(7): 556-561.
7. 马炳奇, 张顺, 张斌, 等. 胰十二指肠切除术后胰瘘发生的相关性因素分析. 中国普通外科杂志, 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. 吴文广, 吴向嵩, 李茂岚, 等. 胰头癌行胰腺全系膜切除75例报告. 中国实用外科杂志, 2013, 33(10): 859-862.
13. 刘仁民, 宗光全, 王峰, 等. 老年胰头癌和壶腹周围癌行胰十二指肠切除术的临床效果. 肝胆胰外科杂志, 2016, 28(3): 181-184.
14. 葛春林, 郭克建. 胰腺癌可切除性的判断. 中国普外基础与临床杂志, 2003, 10(6): 526-527.
15. 郭克建. 胰腺癌诊断方法的一些进展. 中国普外基础与临床杂志, 2002, 9(6): 369-370.
16. 范炜, 薛强, 陈圣开, 等. 保留幽门十二指肠胰头切除术的临床疗效分析. 重庆医学, 2015, 11(2): 226-228.
17. 赵玉沛, 戴梦华. 胰腺癌生物治疗现状与进展. 中国普外基础与临床杂志, 2002, 9(6): 371-373.
18. 刁同进, 赵晓东, 陈新, 等. 胰头癌的外科手术综合治疗143例临床分析. 肝胆胰外科杂志, 2013, 25(5): 376-380, 384.
19. 杜露, 徐新建, 耿城, 等. 联合门静脉/肠系膜上静脉切除的胰十二指肠术治疗胰头癌的疗效. 中国普通外科杂志, 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. 蒋奎荣, 蔡宝宝, 苗毅. 胰腺全系膜切除在胰头癌行胰十二指肠切除术中的应用及意义. 肝胆外科杂志, 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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