ObjectiveTo introduce the method of laparoscopic pancreaticoduodenectomy through an arterial approach, and to evaluate the clinical value of this technique. MethodsThe clinical data of 19 patients with periampullary carcinoma, distal bile duct cancer, and early-stage pancreatic head carcinoma that underwent laparoscopic pancreaticoduodenectomy through an arterial approach in the Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital between September 2010 and July 2013 were retrospectively analyzed. The patients were followed-up until February 28, 2014. ResultsLaparoscopic pancreaticoduodenectomy were successfully performed in all 19 cases, there were no need to convert to open surgery. Open reconstruction was performed in 2 cases, and 17 cases underwent total laparoscopic reconstruction of the digestive tract. The duration of the operations ranged from 5-10.5 h(mean 6.3 h), and the intra-operative blood loss ranged from 170-430 mL(mean 250 mL). Post-surgical pathology detected a mean number of 13.7 lymph(9-21) nodes in all patients. No deaths occurred during the perioperative period. Complications were observed in 42.1%(8/19) of the subjects, including 5 cases with pancreatic fistula, 1 case with bile leak, 1 case with gastric emptying disorder, and 1 case with a gastroduodenal artery aneurysm. The mean length of hospital stay was 10.7 d(7-19 d). The mean followed-up period was 7.5 months(2-28 months), there were 6 patients died of tumor metastasis or recurrence during the followed-up. ConclusionLaparoscopic pancreaticoduodenectomy through an arterial approach simplifies pancreaticoduodenectomy and lymph node dissection procedures, and can completely remove lymph nodes.
Objective To summarize the diagnosis and surgical treatment experience of pancreatic ductal stones combined with pancreatic cancer. Methods Nine cases of pancreatic ductal stones combined with pancreatic cancer who treated in our hospital from January 2005 to December 2015 were collected to make a retrospective analysis, summarizing the clinical features, imaging diagnosis, and surgical treatment. Results Four of 9 cases received ultrasound combined with CT angiography, and all of them were diagnosed as pancreatic ductal stones combined with pancreatic cancer; 4 cases received magnetic resonance cholangiopancreatography (MRCP)/magnetic resonance angiography (MRA), and 3 cases were considered as pancreatic ductal stones combined with pancreatic cancer; 3 cases received endoscopic retrograde cholangiopancreatography (ERCP), and all of them were diagnosed as pancreatic cancer. All of the 9 cases underwent surgery, including 4 cases of pancreaticoduodenectomy, 3 cases of distal pancreatectomy with splenectomy, 1 case of pancreatolithotomy plus distal pancreaticojejunostomy, and 1 case of laparoscopic exploration with biopsy. No one died after surgery, but gastric stress ulcer bleeding happened in 1 case, and class B pancreatic fistula happened in 1 case. All of the 9 cases were followed-up for 5-36 months, with the median were 13 months. Seven cases died during follow up period, 5 cases survived longer than 1 year, and 2 cases survived longer than 3 years. Conclusions For patients with recurrent pancreatic stones, we should be wary of the possibility of combining pancreatic cancer, CT and MRCP can be used as further examination of this disease, a variety of imaging methods combination can improve the diagnosis. If imaging examination reveals swollen pancreas without surgical contraindications, surgery is necessary, and standard pancreaticoduodenectomy or pancreas body and tail resection is recommended.