‘Artery-first’ approaches to pancreatoduodenectomy
Abstract
There are several conceptual approaches to performing
the mobilization stage in pancreatoduodenal resection (PDR). The 'artery-first'
approach allows definitive staging of the tumor process in patients with
suspected involvement of the superior mesenteric vessels before transection of
the isthmus of the pancreas.
Material and methods. In 2006-2020, 73 PDRs were performed, the traditional
method of mobilization was used in 57 patients, according to the principle
'artery-first' in 16 patients. After neoadjuvant chemotherapy, 10 patients were
operated on; the use of the "from the arteries" approach made it
possible to abandon the attempt of radical resection in 3 patients.
Results. The duration of the operation with the traditional
approach and with mobilization 'artery-first' was 5.18 vs 7.2 hours (p=0.0002). Blood loss did not differ
(500 vs 550 ml respectively). Postoperative complications, which required
active treatment and influenced the duration of hospitalization, were noted in
12.5% of patients; there were no differences in them in the groups. The
R0-rate of resections for pancreatic head cancer was 84.8 and 93.75%
respectively (p=0.65). With
traditional PDD, mortality was 5.2%, with mobilization 'artery-first' there
were no lethal outcomes (p=1.0).
Conclusion. The use of the mobilization technique 'artery-first'
does not lead to an increase in the number of postoperative complications and
mortality, but it allows the final staging of the tumor to the point of no
return and increase the radicalism of the PDR.
Keywords:pancreatoduodenal resection; pancreatic cancer; neoadjuvant chemotherapy; mobilization "artery-first"
Funding. The study had no
sponsor support.
Conflict of interests. The authors
declare no conflict of interest.
For citation: Ishchenko R.V.,
Ivanov Yu.V., Smirnov A.V., Danilina E.S., Lysenko A.O. 'Artery-first'
approaches to pancreatoduodenectomy. Clinical and Experimental Surgery.
Petrovsky Journal. 2022; 10 (1): 34-40. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-34-40 (in Russian)
References
1. Kriger A.G., Gorin D.S., Kaldarov A.R., Paklina O.V., Raevskaya M.B., Berelavichus S.V., et al. Methodological aspects and results of pancreatoduodenal resection. Onkologiya. Zhurnal imeni P.A. Gertsena [Oncology. Zhurnal named after P.A. Gertsen]. 2016; 5 (5): 15–21. DOI: https://doi.org/10.17116/onkolog20165515-21 (in Russian)
2. Ishchenko R.V., Lysenko A.O. Artery-fi rst approach for pancreatoduodenal resections. safety and oncological validity (literature review). Khirurgicheskaya praktika [Surgical Practice]. 2020; (1): 5–14. DOI: https://doi.org/10.38181/2223-2427-2020-1-5-14 (in Russian)
3. Tseng J.F., Pisters P.W., Lee J.E., Wang H., Gomez H.F., Sun C.C., et al. The learning curve in pancreatic surgery. Surgery. 2007; 141 (4): 456–63. DOI: https://doi.org/10.1016/j.surg.2006.09.013
4. Gall T.M., Jacob J., Frampton A.E., Krell J., Kyriakides C., Castellano L., et al. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer. JAMA Surg. 2014; 149 (5): 482–5. DOI: https://doi.org/10.1001/jamasurg.2013.3643 PMID: 24599353.
5. Sanjay P., Takaori K., Govil S., Shrikhande S.V., Windsor J.A. «Artery-first» approaches to pancreatoduodenectomy. Br J Surg. 2012; 99 (8): 1027-35. DOI: https://doi.org/10.1002/bjs.8763.)
6. Pessaux P., Varma D., Arnaud J.P. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006; 10 (4): 607-11. DOI: https://doi.org/10.1016/j.gas-sur.2005.05.001 PMID: 16627229.
7. Muttillo E.M., Felli E., Pessaux P. Cattell-Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection. J Surg Oncol. 2020; 122 (8): 1612-5. DOI: https://doi.org/10.1002/jso.26180
8. Leng K.M., Zhong X.Y., Tai S., Kang P.C., Wan M., Jiang X.M., et al. Radical modular pancreatoduodenectomy for pancreatic head cancer using a combination of multiple artery-first approaches technique. Medicine (Baltimore). 2019; 98 (13): e14976. DOI: https://doi.org/10.1097/MD.0000000000014976
9. Ironside N., Barreto S.G., Loveday B., Shrikhande S.V., Windsor J.A., Pandanaboyana S. Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. Br J Surg. 2018; 105 (6): 628-36. DOI: https://doi.org/10.1002/bjs.10832 PMID: 29652079.