3D-laparoscopic pancreaticoduodenectomy with superior mesenteric or portal vein resection for pancreatic cancer
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and Other Interventional Techniques
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3D‑laparoscopic pancreaticoduodenectomy with superior mesenteric or portal vein resection for pancreatic cancer Joachim Geers1 · Halit Topal1 · Joris Jaekers1 · Baki Topal1 Received: 26 May 2020 / Accepted: 24 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Minimally invasive pancreaticoduodenectomy with synchronous vein resection for pancreatic cancer is controversial. The aim of this study was to evaluate outcomes and describe the surgical technique of 3d-laparoscopic pylorusresecting pancreaticoduodenectomy (3dLPD) with venous resection for pancreatic cancer. Methods A retrospective cohort analysis was performed with 26 patients [male/female 11/15; median age 68 (range 45–83) years] who underwent 3dLPD with stented pancreaticogastrostomy and superior mesenteric or portal vein resection for pancreatic adenocarcinoma between November 2016 and June 2019. Median follow-up time after surgery was 12 months (range 3–32). Results Median operating time was 340 min (range 240–420) and intra-operative blood loss was 100 mL (range 0–1000). Type of venous resection and reconstruction was wedge-resection with primary closure (n = 22), wedge-resection with reconstruction using a peritoneal patch (n = 3), and segmental resection with primary end-to-end reconstruction (n = 1). Laparoscopy was converted to open surgery in 4 (15%) patients. Postoperative complications occurred in 10 (38%) patients including severe complications (Clavien–Dindo grade > 2) in 4 (15%). Postoperative mortality was zero. R0 resection was achieved in 21 (81%) patients. Median number of lymph nodes retrieved was 25 (range 10–45). Venous patency was observed in 23 (88%) patients with a median patency duration of 11 months (range 0–31). Conclusions 3dLPD with simultaneous venous resection for pancreatic cancer results in acceptable reconstruction patency and adequacy of surgical oncology without compromising clinical outcomes. Keywords Laparoscopy · Minimally invasive surgery · Pancreatic cancer · Pancreaticoduodenectomy · Vascular resection and reconstruction Pancreaticoduodenectomy (PD) with synchronous vascular resection for pancreatic adenocarcinoma (PC) can be justified if tumor-free (R0) margins are achieved without increased morbidity and mortality [1, 2]. Pancreatic adenocarcinoma is a devastating disease with an overall life expectancy of only 5% at 5 years [3]. Adequate surgical resection is the only chance for patients to be cured from PC, often in combination with chemo(radio)therapy [4]. The NCCN Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07847-3) contains supplementary material, which is available to authorized users. * Baki Topal [email protected] 1
Department of Visceral Surgery, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
guidelines are most commonly used to define resectability of PC [5]. As adequate surgical oncology requires t
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