Application of superior mesenteric artery priority approach in infracolic compartment in surgical treatment of resectable pancreatic head cancer / 中华胰腺病杂志

ABSTRACT

Objective:To investigate the clinical efficacy of superior mesenteric artery priority approach in infracolic compartment in the surgical treatment of resectable pancreatic head cancer.Methods:The clinical data of 79 patients with resectable pancreatic head cancer who underwent radical pancreaticoduodenectomy (PD) in the Department of Hepatobiliary Surgery of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2016 to December 2019 were analyzed retrospectively. According to the surgical approach, they were divided into arterial priority approach group (arterial priority group, 48 cases) and conventional approach group (conventional approach group, 31 cases). The arterial priority group was to first explore the superior mesenteric artery in the subcolone, then cut off the tumor blood supply after ascertaining that the tumor can be removed, and finally remove the tumor and anastomose it routinely. The conventional approach group underwent traditional radical PD. The operation time, intraoperative bleeding, intraoperative blood transfusion, lymph node metastasis, number of lymph node dissections, resection criteria, tumor length diameter, degree of tumor differentiation, occurrence of postoperative complications (pancreatic fistula, impaired gastric emptying, abdominal bleeding, biliary fistula and diarrhea), postoperative hospital stay and postoperative chemotherapy were observed. The patients were followed up by the way of outpatient and/or telephone. The follow-up time was up to March 2021. The survival rate was calculated by Kaplan Meier method.Results:Compared with the conventional approach group, the amount of intraoperative bleeding in the arterial priority group was significantly reduced (400 ml vs 600 ml, P=0.005), the intraoperative blood transfusion rate was significantly reduced (39.6% vs 64.5%, P=0.030), the number of lymph node dissections was significantly increased (19 vs 13, P=0.024), the R 0 resection rate was significantly increased (83.3% vs 58.1%, P=0.013), but the incidence of diarrhea was significantly increased (39.6% vs 16.1%, P=0.027). The differences were statistically significant. The median survival time of arterial priority group and conventional approach group was both 19 months. The overall survival rates of 1, 2 and 3 years were 72.0%, 39.5%, 28.5% and 64.1%, 33.7% and 15.4% respectively. The median tumor free survival time was 15 months and 12 months. There was no significant difference. However, the 1, 2 and 3-year tumor free survival rate of patients in arterial priority group was significantly improved (61.2%, 39.5% and 25.9% vs 46.0%, 21.3% and 7.1%, P=0.042) , and the difference was statistically significant. Conclusions:Superior mesenteric artery priority approach in infracolic compartment can improve R 0 resection rate, prolong postoperative survival time, reduce recurrence and improve prognosis.