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OBJECTIVE: To evaluate the application of three-dimensional visualization technique in total mesopancreas excision(TMpE) for pancreatic head carcinoma. METHODS: From January 2013 to June 2017, 105 TMpE for pancreatic head carcinoma were performed in our institution, and clinical data of these cases were analyzed retrospectively. In order to evaluate the feasibility of operation, three-dimensional visualization techniques were applied to observe the site and size of the pancreatic head tumors, and the relationship between the tumors and peripancreatic vessels before the operation. RESULTS: The median operation time was 239 minutes, and the median blood loss was 409 mL. 29 cases with postoperative complications and no perioperative deaths. 74 patients were considered as R0 resection in final threedimensional pathologic examination, and the rate of R0 resection is 70.5%. CONCLUSION: Preoperative application of three-dimensional visualization technique in TMpE can improve preoperative assessment accuracy and increase the rate of R0 resection, in addition to reduce postoperative complications.
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Objective To study the survival of patients with pancreatic head carcinoma undergoing surgery,and to evaluate the clinicopathological factors associated with prognosis.Methods The data of 4 814 patients who underwent surgery for pancreatic head carcinoma from 2004 to 2009 were extracted from the US SEER database.The life table was used to calculate the survival rate at 5-years.The Kaplan-meier method was used to construct the survival curves of the patients.The univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors.and the univariate analysis was evaluated by the log-rank x2 test.Results The overall 5-year survival of 4 818 pancreatic head carcinoma patients was 16.3％.The median survival was 18.9 months,and the 5-year survival rates of the stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,Ⅲ and Ⅳ patients were 38.8％,35.3％,21.8％,12.2％,9.1％,and 7.3％,respectively.The difference was statistically significant (x2 =287.702;P ＜ 0.05).The factors including sex,age,years of diagnosis,pathological grading,tumor size,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern (all P ＜ 0.05) influenced the survival rate on univariate analysis.There was no clear correlation between race,number of lymph node examined and prognosis.The factors including sex,age,years of diagnosis,pathological grading,tumor size (AJCC 8th),range,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern (all P ＜ 0.05) were independent prognostic factors on multivariate analysis.Conclusions With the increase of TNM staging,the overall survival of patients with pancreatic head carcinoma undergoing surgery gradually decreased.Factors including sex,age,years of diagnosis,pathological grading,tumor size,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern were independent prognostic factors of overall survival.
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Pancreatic cancer is the highest degree of malignancy in the digestive system tumors,longterm prognosis is poor.Pancreatic head cancer has the highest proportion of pancreatic cancer,so its treatment is the focus of the treatment of pancreatic cancer.Radical pancreaticoduodenectomy is the hope of patients with pancreatic head cancer to be cured,but also is the most important treatment for patients with long-term survival.Choosing the appropriate surgical methods and techniques can improve the rate of radical resection of the tumor and reduce the postoperative complications.Combined with timely and appropriate adjuvant therapy,it may improve the quality of life and prolong the survival of resected pancreatic head cancer patients.
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According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience.
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Objective To investigate effect of arterial embolization therapy in the mid-late pancreatic head carcinoma.Methods 13 cases with pancreatic head carcinoma were treated with superselective intra-arterial infusion of gemcitabine by superior pancreaticoduodenal artery followed by arterial embolization using sodium-iodinated oil and 200 mg gemcitabine.Clinical therapeutic effectiveness was evaluated by CT 4 weeks after treatment.Results The clinical symptoms of all patients had obvious improvement and the tumor's size was reduced.Conclusion The therapy of arterial embolization has good clinical effect for pancreatic head carcinoma,and it is one of the most effective therapy at present.