ABSTRACT
OBJECTIVE: To investigate the application and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor. METHODS: The clinical data concerned about 12 patients of pancreatic neck tumor accepted total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways in Changhai Hospital,Naval Military Medical University between March 2015 and March 2017 were analyzed retrospectively. The clinical data especially the data in general situation,operation,hospital stay,perioperative complications,postoperative pathology,condition of surgical margin,postoperative survival time and prognosis were analyzed. RESULTS: All of the 12 patients were diagnosed with pancreatic neck tumor infringing the peripancreatic arteriovenous vein and had accepted total pancreatectomy joint with intravenous resection and reconstruction. The median age of patients was 58 years,whose median BMI reached 23.41,and the number of males was up to 6,equal as females. The information about the operation was as follows:no intraoperative death case,median surgery time being 235 min,median intraoperative blood loss being 800 m L,median plasma-reduced blood transfusion volume being 600 mL,median resection length of vessel being 4.10 cm,median time of portal vein blocking being 15 min. After the operation,9 cases were conducted to large tissue biopsy examination with R0 resection rate of 91.7%. Besides,all the patients were managed with ERAS technique with the postoperative pain relief rate of 100%. Only one case suffered from gastric emptying disorder(Grade A)and two cases had infection. No patients died 30 days after operation,whose median postoperative hospital stay was 12 days and median survival time was 19.8 months. CONCLUSION: The total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways is safe and efficient to treat pancreatic neck tumor,improving operation security and living quality of patients. However,the surgery is so difficult that it could only be applied in certain pancreatic surgery centers with high levels.