ABSTRACT
Objective To study the preoperative diagnosis and treatment strategy of laparoscopic pancreatoduodenectomy (LPD) in patients with arterial anomalies.Methods The clinical data of 16 patients with arterial anomalies who underwent counterclockwise LPD at the Hunan People's Hospital from January 2016 to December 2017 were analyzed.Results The operation time was 370.0±109.0 min.The blood loss was 92.0±45.0 ml.In 14 patients,arterial anomalies were found preoperatively and were confirmed intraoperatively.The number of patients with a replaced right hepatic artery (rRHA),common hepatic artery (CHA) which originated from superior mesenteric artery (SMA),right hepatic artery (RHA) crossing in front of common bile duct (CBD),celiac artery (CA) and SMA with a common origin,right renal artery (RRA) anomaly were 5,3,3,2,and 1,respectively.In 2 patients,the anomalies were not found before operation:a dorsal pancreatic artery (DPA) originating from CHA,and a cystic artery and a right gastric artery (RGA) originating from left hepatic artery (LHA).Operative complications included biochemical fistula in 3 patients;peritoneal local effusion in 2 patients;pleural effusion in 2 patients;gastrointestinal anastomosis bleeding in 1 patient;delayed gastric emptying in 1 patient;a proper hepatic artery (PHA) pseudoaneurysm in 1 patient;and a subumbilical incision infection in 1 patient.The pathological results showed all the 16 patients had malignant tumors of the pancreas or ampulla.All the tumors were resected by R0 resection.Conclusion Arterial anomaly was common in LPD.Preoperative targeted radiological reading of X-rays,regional anatomical division combined with counterclockwise resection could result in early detection,identification and help to protect the arterial anomaly from injury and reduce the risk of serious postoperative complications.
ABSTRACT
Objective To analyze our experience on laparoscopic and Da Vinci robotic radical pancreaticoduodenectomy combined with major vascular resection and reconstruction,and to expand the indications of surgery for patients with pancreatic cancer.Methods From December 2013 to January 2016,67 patients underwent laparoscopic and Da Vinci robotic pancreaticoduodenectomy in our department.The resection was combined with major vein resection in 5 patients.We retrospectively analyzed the clinical data of these patients who had laproscopic or Da Vinci robotic pancreaticoduodenectomy with major vascular resection and reconstruction.Results The mean operation time was 378 (360 ～ 480) minutes,and the mean estimated blood loss was 360 (120 ～450) ml.4 patients underwent laparoscopic wedge-resection of PV/SMV without interruption of blood flow.After pancreaticoduodenectomy using the superior mesentery artery first approach,one patient underwent resection of a segment of portal vein and superior mesenteric vein followed by an end to end anastomosis using the Da Vinci robotic system.The total blood flow occlusion time was 35 minutes.Intraoperative frozen section biopsy and postoperative pathological results were chronic pancreatitis with pancreatic cancer in all these patients.The veins were invaded by tumor in 3 patients.In the remaining 2 patients,the vascular wall showed chronic inflammation.All the surgical resection margins were tumor negative.Postoperative complications included one patient with bile leakage,one patient with upper gastrointestinal bleeding and one patient with a grade A pancreatic fistula (PF).The patient with upper gastrointestinal bleeding was managed successfully using hemostatic treatment under gastroscopy,and the other patients all recovered well after conservative therapy.There was no death in this study.The mean postoperative hospitalization stay was 14 (9 ～35) days.Conclusions Laparoscopic or Da Vinci robotic radical pancreaticoduodenectomy combined with major vascular resection is safe and feasible in selected patients with pancreatic cancer.However,surgeons need to be experienced at both open pancreaticoduodenectomy combined with vascular resection and at standard laparoscopic pancreaticoduodenectomy.