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Total Superior Mesenteric Artery Nerve Plexus Preservation During Pancreaticoduodenectomy for Pancreatic Cancer

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Abstract

Background

Superior mesenteric artery (SMA) nerve plexus (PLsma) dissection has been performed to achieve R0 resection in pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) in high-volume centers. However, full-extent PLsma preservation in PD is employed in our institution. The feasibility of the PLsma preservation strategy was investigated.

Methods

Between January 2010 and December 2020, 156 patients underwent PLsma preservation PD for PDAC at our institution. Of these, 118 patients had resectable PDAC (R group) and 38 patients had borderline resectable artery (BR-A group). Clinical and oncological outcomes focusing on local recurrence, patient prognoses, and morbidities (including postoperative refractory diarrhea) were retrospectively analyzed and our postoperative outcomes were compared with those of other institutions.

Results

Pathological R0 resection by PLsma preservation PD was achieved in 96 R group patients (81.4%) and 27 BR-A group patients (71.1%). The median postoperative hospital stay was 15.0 days in both groups. Local site-only recurrence was observed in 10.2% (12/118) of R-group and 10.5% (4/38) of BR-A-group patients, whereas distant site-only recurrence occurred in 21.2% (25/118) of R-group and 28.9% (11/38) of BR-A-group patients. Median survival times were 64.3 months (R group) and 35.4 months (BR-A group, p = 0.07). Median disease-free survival (DFS) times were 31.0 months (R group) and 12.0 months (BR-A group). No diarrhea requiring opioids was observed in either group. These results were equal or superior to those of PLsma dissection PD in other institutions.

Conclusions

PLsma preservation in PD was feasible compared to PLsma dissection in recurrence and overall survival.

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Acknowledgements

The authors thank Dr. Bryan J. Mathis of the University of Tsukuba Hospital International Medical Center for scientific discussion, advice on paper structure, and language revision.

Funding

The authors received no grant support.

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Authors and Affiliations

  1. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan

    Yoshihiro Miyazaki, Tatsuya Oda, Osamu Shimomura, Shinji Hashimoto, Manami Doi, Kazuhiro Takahashi, Yohei Owada, Kinji Furuya, Koichi Ogawa, Yusuke Ohara, Yoshimasa Akashi & Tsuyoshi Enomoto

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  1. Yoshihiro Miyazaki
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  2. Tatsuya Oda
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  6. Kazuhiro Takahashi
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Correspondence to Tatsuya Oda.

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This study was approved by the Institutional Review Board of the University of Tsukuba Hospital (R01-030).

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Miyazaki, Y., Oda, T., Shimomura, O. et al. Total Superior Mesenteric Artery Nerve Plexus Preservation During Pancreaticoduodenectomy for Pancreatic Cancer. World J Surg 47, 2816–2824 (2023). https://doi.org/10.1007/s00268-023-07111-4

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