目的:局部晚期胰腺导管腺癌(PDAC)具有不可重建的肠系膜上静脉(SMV)侵犯是国家综合癌症网络指南中不可切除的标准之一。化疗的进展改善了降期和转换手术的结果,从而扩大局部先进的PDAC的手术选择。然而,具有不可重建SMV的PDAC的操作记录较少。如果抵押路线发育良好,可以保存或重建,无需重建即可进行SMV切除。在本文中,我们详细介绍了我们的手术技术和接受胰十二指肠切除术合并SMV切除和非重建(PD-SMVR-NR)的患者的结局.
方法:所有在准腾多大学医院接受PD的胰头癌患者,Japan,在2019年1月至2022年12月期间,我们从前瞻性维护的术前数据库进行评估.人口统计数据,临床病史,手术记录,发病率,死亡率,和病理资料进行了审查。
结果:在我们研究所工作了四年,161例胰头癌患者接受PD,其中86例患者接受PD门静脉(PV)或SMV切除术。有3例患者接受了PD-SMVR-NR。每位患者都有发达的侧支血管绕过SMV的阻塞段。所有3例患者均无可接受的并发症(Clavien-Dindo2级)的住院死亡率。2例患者取得R0切除。
结论:通过了解静脉血流动力学和保留侧支血管,尤其是右结肠上静脉拱廊和肠系膜-脾汇合,胰十二指肠切除术与肠系膜上静脉切除和非重建可以安全地进行。
OBJECTIVE: Locally advanced pancreatic ductal adenocarcinoma (PDAC) with an unreconstructible superior mesenteric vein (SMV) invasion is one of the criteria of unresectability in the National Comprehensive Cancer Network guidelines. Advances in chemotherapy have improved downstaging and conversion surgery outcomes, thereby broadening surgical options for locally advanced PDAC. However, operations for PDAC with an unreconstructible SMV is less well-documented. If the collateral route is well-developed and can be preserved or reconstructed, SMV resection can be performed without reconstruction. In this paper, we detail our surgical technique and the outcomes for patients undergoing pancreatoduodenectomy with SMV resection and non-reconstruction (PD-SMVR-NR).
METHODS: All consecutive patients with pancreatic head cancer who underwent PD at Juntendo University Hospital, Japan, between January 2019 and December 2022 were evaluated from a prospectively maintained preoperative database. Demographic data, clinical history, operative record, morbidity, mortality, and pathologic data were reviewed.
RESULTS: Over four years at our Institute, 161 patients with pancreatic head cancer underwent PD, and 86 of these patients underwent PD with portal vein (PV) or SMV resection. There were three patients who underwent PD-SMVR-NR. Each patient had well-developed collateral vessels bypassing the obstructed segment of the SMV. All three patients had no hospital mortality with acceptable complications (Clavien-Dindo grade 2). Two patients achieved R0 resection.
CONCLUSIONS: By understanding the hemodynamics of venous flow and preserving collateral vessels, especially the superior right colic vein arcade and porto-mesenterico-splenic confluence, pancreatoduodenectomy with superior mesenteric vein resection and non-reconstruction can be performed safely.