Feasibility and safety analysis of laparoscopic pancreaticoduodenectomy and total pancreatectomy combined with portal vein-superior mesenteric vein resection and reconstruction
SUN Meng-qing
CHEN Shao-bo
HONG Xia-fei
DONG Liang-bo
HE Xiao-dong
HAN Xian-lin
Abstract：Objective To analyze technical highlights,safety and feasibility of laparoscopic pancreaticoduodenectomy(LPD)and laparoscopic total pancreatectomy(LTP)combined with portal vein-superior mesenteric vein(PV-SMV)resection and reconstruction.Methods The clinical data of 13 patients who underwent LPD and LTP combined with PV-SMV resection and reconstruction in Peking Union Medical College Hospital from May 2022 to September 2023 were retrospectivly analyzed.Results Among the 13 patients,10 underwent LPD,and 3 underwent LTP.Seven patients(53.8％)underwent PV-SMV sidewall resection and closure,4 patients(30.8％)underwent PV-SMV segmental resection with end-to-end anastomosis,and 2 patients(15.4％)underwent PV-SMV segmental resection with artificial vascular bridging.The mean operative time was(314.2±70.5)minutes,with intraoperative blood loss of(442.3±247.4)mL.The median PV-SMV occlusion time was 22(8-80)minutes.One patient experienced delayed gastric emptying postoperatively.There was no occurrences of grade B or higher pancreatic fistula,postoperative bleeding,intra-abdominal infection,bile leakage,reoperation,acute thromboembolic events,or perioperative death within 30 days in this study.The mean postoperative hospital stay was(10.7± 4.7)days.Pathological examination revealed one case of undifferentiated carcinoma with giant cells in the pancreas and 12 cases of pancreatic ductal adenocarcinoma.The mean tumor size was(3.9±1.6)cm.Intraoperatively,(25.7±12.7)lymph nodes were dissected,with lymph node metastasis observed in 9 cases(69.2％).Postoperative pathological examination confirmed portal vein invasion in 5 cases(38.5％).All patients achieved R0 resection.Postoperative portal vein patency rate was 100.0％.Conclusion For experienced minimally invasive pancreatic surgery teams,LPD or LTP combined with PV-SMV resection and reconstruction is safe and feasible for patients with PV-SMV involvement in selected cases of pancreatic head cancer,improving the R0 resection rate and benefiting the patients.
Keywords：laparoscopic pancreaticoduodenectomylaparoscopic total pancreatectomypancreatic cancerportal vein-superior mesenteric vein resection and reconstruction
Publication Date：2024-02-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 199-204 )