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Total meso-pancreatoduodenum excision with pancreaticoduodenectomy in lower biliary tract cancer

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Abstract

Background

Incomplete tumor resection with insufficient lymphadenectomy following a pancreaticoduodenectomy (PD) for lower biliary tract cancer results in a dismal outcome. This study aimed to compare the short-term outcomes of PD between total meso-pancreatoduodenum excision (tMPDe) and the conventional procedure for lower biliary tract cancer.

Methods

Patients who underwent PD for lower biliary tract cancer between May 2003 and March 2015 were included in this study. We have devised a new surgical technique, tMPDe, as a mesenteric plane surgery with an artery-first approach, for achieving complete clearance of the peripancreatic retroperitoneal tissue and lymph nodes. Perioperative data, including complications and short-term survival, were evaluated.

Results

A total of 74 consecutive patients underwent a PD: 41 patients underwent conventional PD (cPD), and 33 underwent tMPDe. The tumor stages were similar in the two study groups. R0 was achieved in 32 patients (78.0 %) with cPD and in 31 patients (93.9 %) with tMPDe (p = 0.046). The survival rates at 1 and 3 years after surgery were 82.5 and 64.0 % for the cPD group, with a median follow-up period of 44.6 months, and 92.8 and 84.4 % for the tMPDe group, with a median follow-up period of 28.6 months, respectively.

Conclusions

The tMPDe technique significantly increased R0 resection and contributed to better oncological outcomes in lower biliary tract cancer.

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Authors and Affiliations

  1. Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Yasunari Kawabata, Hikota Hayashi & Yoshitsugu Tajima

  2. Department of Organ Pathology, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Noriyoshi Ishikawa

Authors
  1. Yasunari Kawabata
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  2. Hikota Hayashi
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  3. Noriyoshi Ishikawa
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  4. Yoshitsugu Tajima
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Corresponding author

Correspondence to Yasunari Kawabata.

Ethics declarations

Research involving human participants and/or animals informed consent

The study was approved by the Institutional Review Board of the Shimane University Hospital. At the time of the start point of this study, the purpose of the present study was explained to each patient and their families and an informed consent was obtained with document. Furthermore, adequate care was taken to protect the privacy of the individuals participating in the study. Each patient was informed of the present study’s intent to not use the clinical data from this study for any purpose other than for present study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Kawabata, Y., Hayashi, H., Ishikawa, N. et al. Total meso-pancreatoduodenum excision with pancreaticoduodenectomy in lower biliary tract cancer. Langenbecks Arch Surg 401, 463–469 (2016). https://doi.org/10.1007/s00423-016-1435-y

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  • DOI: https://doi.org/10.1007/s00423-016-1435-y

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