Experience of different arterial priority approaches in laparoscopic pancreaticoduodenectomy combined with resection and reconstruction of superior mesenteric vein-portal vein_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xingxing , XU Jie , WANG Jiaguo , YOU Ke ,  LIU Zuojin

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

LIU Zuojin, Email: 300376@hospital.cqmu.edu.cn

Keywords：

pancreaticoduodenectomy; laparoscope; arterial priority approach; revascularization

DOI：

10.7507/1007-9424.202206079

Video：

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Objective To investigate the advantage of superior mesenteric artery approach in laparoscopic pancreaticoduodenectomy (LPD) combined with superior mesenteric vein (SMV)-portal vein (PV) resection and reconstruction. Method The operation process of a pancreatic head cancer patient with SMV-PV invasion admitted to the Second Affiliated Hospital of Chongqing Medical University in April 2022 was summarized. Results The resection and reconstruction of SMV-PV during the LPD through the right posterior approach and anterior approach of superior mesenteric artery was completed successfully. The operation time was 7.5 h, the intraoperative blood loss was 200 mL, and the SMV-PV resection and reconstruction time was 20 min. The patient was discharged with a better health condition on the 9th day after operation. Conclusion From the operation process of this patient, the arterial priority approache is a safe and effective approach in the resection and reconstruction of SMV-PV during the LPD.

Citation： WANG Xingxing, XU Jie, WANG Jiaguo, YOU Ke, LIU Zuojin. Experience of different arterial priority approaches in laparoscopic pancreaticoduodenectomy combined with resection and reconstruction of superior mesenteric vein-portal vein. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1266-1269. doi: 10.7507/1007-9424.202206079 Copy

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2.	Kornaropoulos M, Moris D, Beal EW, et al. Total robotic pancreaticoduodenectomy: a systematic review of the literature. Surg Endosc, 2017, 31(11): 4382-4392.
3.	Mabrut JY, Fernandez-Cruz L, Azagra JS, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery, 2005, 137(6): 597-605.
4.	Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc, 2015, 29(1): 9-23.
5.	梁贇, 王巍. 腹腔镜胰十二指肠切除术手术入路的选择. 中国普外基础与临床杂志, 2021, 28(9): 1125-1128.
6.	Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7.	王志东, 姜兴明, 钟翔宇, 等. 联合应用多种动脉优先入路胰十二指肠切除术的经验总结. 中华外科杂志, 2016, 54(11): 854-858.
8.	Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol, 2012, 38(4): 340-345.
9.	Peparini N, Chirletti P. Mesopancreas: a boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol, 2013, 39(12): 1303-1308.
10.	Glebova NO, Hicks CW, Tosoian JJ, et al. Outcomes of arterial resection during pancreatectomy for tumor. J Vasc Surg, 2016, 63(3): 722-729.
11.	Jegatheeswaran S, Baltatzis M, Jamdar S, et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford), 2017, 19(6): 483-490.
12.	Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg, 2009, 13(4): 784-792.
13.	Selvaggi F, Mascetta G, Daskalaki D, et al. Outcome of superior mesenteric-portal vein resection during pancreatectomy for borderline ductal adenocarcinoma: results of a prospective comparative study. Langenbecks Arch Surg, 2014, 399(5): 659-665.
14.	Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
15.	崔云甫. 先行肠系膜上动脉入路的胰十二指肠切除术. 中国现代普通外科进展, 2009, 12(12): 1018-1019.
16.	Dumitrascu T, David L, Popescu I. Posterior versus standard approach in pancreatoduodenectomy: a case-match study. Langenbecks Arch Surg, 2010, 395(6): 677-684.
17.	彭兵, 孟令威. 腹腔镜胰十二指肠切除术术中出血的处理经验. 中华腔镜外科杂志(电子版), 2019, 12(5): 260-263.
18.	Dua MM, Tran TB, Klausner J, et al. Pancreatectomy with vein reconstruction: technique matters. HPB(Oxford), 2015, 17(9): 824-831.

1. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
2. Kornaropoulos M, Moris D, Beal EW, et al. Total robotic pancreaticoduodenectomy: a systematic review of the literature. Surg Endosc, 2017, 31(11): 4382-4392.
3. Mabrut JY, Fernandez-Cruz L, Azagra JS, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery, 2005, 137(6): 597-605.
4. Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc, 2015, 29(1): 9-23.
5. 梁贇, 王巍. 腹腔镜胰十二指肠切除术手术入路的选择. 中国普外基础与临床杂志, 2021, 28(9): 1125-1128.
6. Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7. 王志东, 姜兴明, 钟翔宇, 等. 联合应用多种动脉优先入路胰十二指肠切除术的经验总结. 中华外科杂志, 2016, 54(11): 854-858.
8. Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol, 2012, 38(4): 340-345.
9. Peparini N, Chirletti P. Mesopancreas: a boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol, 2013, 39(12): 1303-1308.
10. Glebova NO, Hicks CW, Tosoian JJ, et al. Outcomes of arterial resection during pancreatectomy for tumor. J Vasc Surg, 2016, 63(3): 722-729.
11. Jegatheeswaran S, Baltatzis M, Jamdar S, et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford), 2017, 19(6): 483-490.
12. Müller SA, Hartel M, Mehrabi A, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg, 2009, 13(4): 784-792.
13. Selvaggi F, Mascetta G, Daskalaki D, et al. Outcome of superior mesenteric-portal vein resection during pancreatectomy for borderline ductal adenocarcinoma: results of a prospective comparative study. Langenbecks Arch Surg, 2014, 399(5): 659-665.
14. Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg, 2008, 247(2): 300-309.
15. 崔云甫. 先行肠系膜上动脉入路的胰十二指肠切除术. 中国现代普通外科进展, 2009, 12(12): 1018-1019.
16. Dumitrascu T, David L, Popescu I. Posterior versus standard approach in pancreatoduodenectomy: a case-match study. Langenbecks Arch Surg, 2010, 395(6): 677-684.
17. 彭兵, 孟令威. 腹腔镜胰十二指肠切除术术中出血的处理经验. 中华腔镜外科杂志(电子版), 2019, 12(5): 260-263.
18. Dua MM, Tran TB, Klausner J, et al. Pancreatectomy with vein reconstruction: technique matters. HPB(Oxford), 2015, 17(9): 824-831.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of different arterial priority approaches in laparoscopic pancreaticoduodenectomy combined with resection and reconstruction of superior mesenteric vein-portal vein

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