Abstract
Background
In patients having locally advanced cancer of the stomach with suspected tumor infiltration to the pancreatic head or the duodenum, a concurrent pancreaticoduodenectomy with gastrectomy is occasionally prerequisite to achieve a microscopically tumor-free surgical margin.
Materials and methods
We present the first series of successful totally laparoscopic pancreaticoduodenectomy (TLPD) for advanced gastric cancer with suspected infiltration to the pancreatic head.
Results
TLPD was successfully performed without adverse events during surgery and resulted in favorable short-term outcomes of three patients with locally advanced gastric cancer with suspected invasion to the pancreas.
Conclusions
Although TLPD for locally advanced gastric cancer is a technically difficult challenging operation that requires careful dissection along the major vessels, intracorporeal tie sutures, and the placement of an external drainage tube into a narrow pancreatic duct, this procedure is technically feasible and safe in the hands of experienced surgeons. Long-term follow-up is mandatory to validate oncological outcome.
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References
Shchepotin IB, Chorny VA, Nauta RJ, Shabahang M, Buras RR, Evans SR (1998) Extended surgical resection in T4 gastric cancer. Am J Surg 175:123–126. doi:10.1016/S0002-9610(97)00268-7
Saka M, Mudan SS, Katai H, Sano T, Sasako M, Maruyama K (2005) Pancreaticoduodenectomy for advanced gastric cancer. Gastric Cancer 8:1–5. doi:10.1007/s10120-004-0298-z
Nunobe S, Hiki N, Ohyama S, Fukunaga T, Seto Y, Yamaguchi T (2008) Survival benefits of pancreatoduodenectomy for gastric cancer: relationship to the number of lymph node metastasis. Langenbecks Arch Surg 393:157–162. doi:10.1007/s00423-007-0248-4
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, the Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncological outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72. doi:10.1097/01.sla.0000225364.03133.f8
Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810. doi:10.1001/archsurg.135.7.806
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer. Ann Surg 241:232–237. doi:10.1097/01.sla.0000151892.35922.f2
Goh PM, So JB (1999) Role of laparoscopy in the management of stomach cancer. Semin Surg Oncol 16:327–331. doi:10.1002/(SICI)1098-2388(199906)16:4<321::AID-SSU7>3.0.CO;2-F
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234. doi:10.1007/s101200050069
Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV (2007) Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg 205:222–230. doi:10.1016/j.jamcollsurg.2007.04.004
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410. doi:10.1007/BF00642443
Dulucq JL, Wintringer P, Mahajna A (2006) Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc 20:1045–1050. doi:10.1007/s00464-005-0474-1
Uyama I, Ogiwara H, Iida S, Takahara T, Furuta T, Kikuchi K (1996) Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc 6:405–410. doi:10.1097/00019509-199610000-00016
Yeo CJ, Cameron JL, Lillemore KD, Sauter PK, Coleman J, Sohn TA, Campbell KA, Choti MA (2000) Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 232:419–429. doi:10.1097/00000658-200009000-00014
Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246:425–433. doi:10.1097/SLA.0b013e3181492c28
Kakita A, Takahashi T, Yoshida M, Furuta K (1996) A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today 26:532–535. doi:10.1007/BF00311562
Sobin LH, Wittekind CH (2002) TNM classification of malignant tumors, 6th edn. Springer, Heidelberg
Acknowledgment
The authors are grateful to Professor Tetsuji Fujita, MD, Department of Surgery, The Jikei University School of Medicine, for critical reading of the manuscript.
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Shinohara, T., Uyama, I., Kanaya, S. et al. Totally laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer. Langenbecks Arch Surg 394, 733–737 (2009). https://doi.org/10.1007/s00423-009-0492-x
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DOI: https://doi.org/10.1007/s00423-009-0492-x