Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach
- 52 Downloads
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.
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.
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.
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.
KeywordsLaparoscopic Minimal invasive surgery Pancreatectomy Pancreaticoduodenectomy Vascular resection
Compliance with ethical standards
Dr. Yunqiang Cai, Pan Gao, Yongbin Li, Xin Wang, and Bing Peng have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MP4 242747 KB)
- 6.Palanisamy S, Deuri B, Naidu SB, Vaiyapurigoundar Palanisamy N, Natesan AV, Palanivelu PR, Parthasarathy R, Palanivelu C (2015) Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: one step forward. Asian J Endosc Surg 8:468–472CrossRefPubMedGoogle Scholar
- 12.Kantor O, Talamonti MS, Sharpe S, Lutfi W, Winchester DJ, Roggin KK, Bentrem DJ, Prinz RA, Baker MS (2017) Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg 213:512–515CrossRefPubMedGoogle Scholar
- 21.Shrikhande SV, Barreto SG, Bodhankar YD, Suradkar K, Shetty G, Hawaldar R, Goel M, Shukla PJ (2011) Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes. Langenbecks Arch Surg 396:1205–1212CrossRefPubMedGoogle Scholar