Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Hongxiang , XU Jie , WANG Jiaguo , YOU Ke ,  LIU Zuojin

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, P. R. China;

Corresponding author：

LIU Zuojin, Email: 300376@hospital.cqmu.edu.cn

Keywords：

laparoscopic pancreaticoduodenectomy; posterior approach; uncinate-process-first

DOI：

10.7507/1007-9424.202309032

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Objective To explore the safety and feasibility of the uncinate-process-first superior mesenteric artery (SMA) right posterior approach in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of 5 patients admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2022 to May 2023 were retrospectively analyzed, all patients underwent uncinate-process-first SMA right posterior approach during LPD. Results All 5 cases of LPD with uncinate-process-first SMA right posterior approach were successfully completed. The operative time was (366±51) min, the intraoperative blood loss was (140±42) mL, and the postoperative hospital stay was (11±2) days. All the postoperative pathological findings reached R0 resection. None of the 5 patients suffered from biliary leakage, bleeding, or gastrointestinal empties, and 2 patients suffered from biochemical fistula, the postoperative follow-up time was (7±2) months, and there was no recurrence during the follow-up period. Conclusion The uncinate-process-first SMA right posterior approach is a safe and feasible surgical approach, especially for tumors with no obvious vascular invasion and diameter ≤2 cm.

Citation： WANG Hongxiang, XU Jie, WANG Jiaguo, YOU Ke, LIU Zuojin. Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1289-1293. doi: 10.7507/1007-9424.202309032 Copy

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2.	中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南 (2021). 中国实用外科杂志, 2021, 41(7): 725-738.
3.	Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
4.	牛河源, 孟兴凯. 基于胰腺系膜解剖探讨胰十二指肠切除术手术入路的选择. 肝胆胰外科杂志, 2022, 34(11): 696-699, 705.
5.	梁贇, 王巍. 腹腔镜胰十二指肠切除术手术入路的选择. 中国普外基础与临床杂志, 2021, 28(9): 1125-1128.
6.	Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7.	王小明, 孙卫东, 胡明华, 等. 右后下入路动脉先行的腹腔镜胰十二指肠切除术. 中华胃肠外科杂志, 2016, 19(1): 71-74.
8.	高文涛, 奚春华, 涂敏, 等. 腹腔镜下Treitz韧带途径钩突优先、动脉优先入路胰十二指肠切除术的临床应用. 中华外科杂志, 2017, 55(5): 359-363.
9.	Morales E, Zimmitti G, Codignola C, et al. Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy. Surg Endosc, 2019, 33(12): 4186-4191.
10.	王巍, 姜翀弋, 陈寅涛, 等. 腹腔镜胰十二指肠切除术钩突部位动脉解剖研究. 中国实用外科杂志, 2016, 36(2): 206-209,213.
11.	梁贇, 王巍, 姜翀弋, 等. 动脉优先入路处理胰腺钩突在腹腔镜胰十二指肠切除术中的应用. 中华肝脏外科手术学电子杂志, 2017, 6(1): 19-23.
12.	Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961. doi: 10.1038/s41598-019-49455-9.
13.	Nickel F, Haney CM, Kowalewski KF, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg, 2020, 271(1): 54-66.
14.	杨帆, 刘亚辉, 刘松阳, 等. 完全腹腔镜“下入路, 钩突优先, 动脉先行”胰十二指肠切除术的临床应用. 中国微创外科杂志, 2018, 18(10): 908-910.
15.	黄孝伦, 邹海波, 赖春友, 等. 海德堡三角清扫胰十二指肠切除术治疗胰头癌的临床疗效. 中华消化外科杂志, 2022, 21(4): 500-506.
16.	Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
17.	程智猛, 程南生, 熊先泽, 等. 胰十二指肠切除术后胃瘫的危险因素分析. 中国普外基础与临床杂志, 2016, 23(8): 1018-1023.
18.	Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
19.	蔡凤军, 王晓栋, 杨永生. 胰腺癌行胰十二指肠切除术中淋巴结清扫的争议与思考. 肝胆胰外科杂志, 2023, 35(8): 449-453, 458.
20.	Okano K, Hirao T, Unno M, et al. Postoperative infectious complications after pancreatic resection. Br J Surg, 2015, 102(12): 1551-1560.
21.	Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22.	Sugiura T, Mizuno T, Okamura Y, et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg, 2015, 102(12): 1561-1566.
23.	谭志健, 沈展涛, 刘一峰, 等. No-touch技术在胰头癌腹腔镜胰十二指肠切除术中的初步效果. 中华肝胆外科杂志, 2020, 26(8): 569-572.
24.	陈庆民, 刘松阳, 王英超, 等. “结肠后入路-钩突先行”在腹腔镜胰十二指肠切除术中应用研究. 中国实用外科杂志, 2019, 39(12): 1321-1325.
25.	肖杰, 周涛, 孙占虎, 等. 动脉入路胰腺全系膜切除胰十二指肠切除术治疗胰头癌的临床效果观察. 临床误诊误治, 2022, 35(7): 64-67.

1. Chiorean EG, Chiaro MD, Tempero MA, et al. Ampullary Adenocarcinoma, Version 1. 2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2023, 21(7): 753-782.
2. 中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南 (2021). 中国实用外科杂志, 2021, 41(7): 725-738.
3. Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
4. 牛河源, 孟兴凯. 基于胰腺系膜解剖探讨胰十二指肠切除术手术入路的选择. 肝胆胰外科杂志, 2022, 34(11): 696-699, 705.
5. 梁贇, 王巍. 腹腔镜胰十二指肠切除术手术入路的选择. 中国普外基础与临床杂志, 2021, 28(9): 1125-1128.
6. Sanjay P, Takaori K, Govil S, et al. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 2012, 99(8): 1027-1035.
7. 王小明, 孙卫东, 胡明华, 等. 右后下入路动脉先行的腹腔镜胰十二指肠切除术. 中华胃肠外科杂志, 2016, 19(1): 71-74.
8. 高文涛, 奚春华, 涂敏, 等. 腹腔镜下Treitz韧带途径钩突优先、动脉优先入路胰十二指肠切除术的临床应用. 中华外科杂志, 2017, 55(5): 359-363.
9. Morales E, Zimmitti G, Codignola C, et al. Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy. Surg Endosc, 2019, 33(12): 4186-4191.
10. 王巍, 姜翀弋, 陈寅涛, 等. 腹腔镜胰十二指肠切除术钩突部位动脉解剖研究. 中国实用外科杂志, 2016, 36(2): 206-209,213.
11. 梁贇, 王巍, 姜翀弋, 等. 动脉优先入路处理胰腺钩突在腹腔镜胰十二指肠切除术中的应用. 中华肝脏外科手术学电子杂志, 2017, 6(1): 19-23.
12. Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961. doi: 10.1038/s41598-019-49455-9.
13. Nickel F, Haney CM, Kowalewski KF, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg, 2020, 271(1): 54-66.
14. 杨帆, 刘亚辉, 刘松阳, 等. 完全腹腔镜“下入路, 钩突优先, 动脉先行”胰十二指肠切除术的临床应用. 中国微创外科杂志, 2018, 18(10): 908-910.
15. 黄孝伦, 邹海波, 赖春友, 等. 海德堡三角清扫胰十二指肠切除术治疗胰头癌的临床疗效. 中华消化外科杂志, 2022, 21(4): 500-506.
16. Schneider M, Hackert T, Strobel O, et al. Technical advances in surgery for pancreatic cancer. Br J Surg, 2021, 108(7): 777-785.
17. 程智猛, 程南生, 熊先泽, 等. 胰十二指肠切除术后胃瘫的危险因素分析. 中国普外基础与临床杂志, 2016, 23(8): 1018-1023.
18. Ellis RJ, Gupta AR, Hewitt DB, et al. Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection. J Surg Oncol, 2019, 119(7): 925-931.
19. 蔡凤军, 王晓栋, 杨永生. 胰腺癌行胰十二指肠切除术中淋巴结清扫的争议与思考. 肝胆胰外科杂志, 2023, 35(8): 449-453, 458.
20. Okano K, Hirao T, Unno M, et al. Postoperative infectious complications after pancreatic resection. Br J Surg, 2015, 102(12): 1551-1560.
21. Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22. Sugiura T, Mizuno T, Okamura Y, et al. Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection. Br J Surg, 2015, 102(12): 1561-1566.
23. 谭志健, 沈展涛, 刘一峰, 等. No-touch技术在胰头癌腹腔镜胰十二指肠切除术中的初步效果. 中华肝胆外科杂志, 2020, 26(8): 569-572.
24. 陈庆民, 刘松阳, 王英超, 等. “结肠后入路-钩突先行”在腹腔镜胰十二指肠切除术中应用研究. 中国实用外科杂志, 2019, 39(12): 1321-1325.
25. 肖杰, 周涛, 孙占虎, 等. 动脉入路胰腺全系膜切除胰十二指肠切除术治疗胰头癌的临床效果观察. 临床误诊误治, 2022, 35(7): 64-67.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy

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