Artery first versus traditional approach in pancreatoduodenectomy for pancreatic head cancer

Authors

  • Ali Zedan Tohamy Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
  • Hanan A. Eltyb Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
  • Marwa T. Hussien Department of Oncologic Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
  • Haisam Atta Department Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20205420

Keywords:

Artery-first approach, Traditional approach, Pancreatoduodenectomy, Whipple

Abstract

Background: Artery first approach pancreatoduodenectomy (AFAPD) technique is one of the many modifications of the standard whipple procedure (sPD) thus enabling a complete dissection of the right side of this artery and of the portal vein, as well as a complete excision of the retroportal pancreatic lamina. Objective was to evaluate the clinical, perioperative and oncological outcomes of “artery first” approach compared with those of the traditional approach.

Methods: Between 2010 and 2019, The present study includes two groups of patients. A first group of 28 patients with PD by “artery first” and a second group including 28 matched patients with PD by TAPD. Demographic characteristics (sex, age), intraoperative data (approach type, operative time, blood loss, intraoperative complications, need for vascular resections), histological diagnosis and pathology data (tumor location, TNM staging, tumor grading, tumor vascular invasion) and patient outcomes (postoperative length of stay, in-hospital postoperative mortality and morbidity, survival time) were collected.

Results: There were no significant differences between the two groups regarding: total operative time (422 vs. 460.min, p=0.19), estimated blood loss (p=0.67), median length of stay (14 days in both groups) (p=0. 0.39), complication rates (32.1% and 35.7%) (p=0. 1.00), lymph node yield (22 and 21) and R0 resection rate (75% and 67.9%).  

Conclusions: We concluded that artery first” offers similar operative time, intraoperative blood loss, R0 resection rates, lymph node yield and long-term survival as TAPD.

References

Dua F, Wanga X, Lina H, Zhaoa X. Pancreaticoduodenectomy With Arterial Approach of Total Mesenteric Resection of the Pancreas for Pancreatic Head Cancer. Gastroenterol Res. 2019;12(5):256-62.

Bin X, Lian B, Jianping G, Bin T. Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy. J Int Medic Res. 2018;46(1):403-10.

Georgescu S, Ursulescu C, Grigorean VT, Lupascu C. Hind right approach pancreaticoduodenectomy: from skill to indications. Gastroenterol Res Pract. 2014;12:1678.

Pandanaboyana S, Loveday B, Windsor JA. Artery First Approach to Pancreatic Cancer Resection: A Review of the Evidence for Benefit. J Pancreas. 2017;18(5):369-71.

Hirono S, Kawai M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, et al. Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg. 2017;1:208-18.

Dumitrascu T, David L, Popescu L. Posterior versus standard approach in pancreatoduodenectomy: a case-match study. Langenbecks Arch Surg. 2010,395:677-84

Chowdappa R, Challa VR. Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature. Ind J Surg Oncol. 2015;6(1):69-74.

Cao Z, JXu J, Shao O, Zhang T, Zhao Y. Surgical treatment of pancreatic head cancer: concept revolutions and arguments. Chin J Cancer Res. 2015;27(4):392-6.

Gaedcke J, Gunawan BM. The Mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trialsGrade & R. Szöke & T. Liersch & H. Becker & B. M. Ghadimi. The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials. Langenbecks Arch Surg. 2010;395:451-8

Jeyarajah DR, Khithani A, Siripurapu V, Liu E, Thomas A, Saad AJ. Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter. HPB. 2014;16:263-6

Westermark S, Rangelova E, Ansorge C, Lundel L, Segersvärd R, Chiaro MC et al. Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy. Langenbecks Arch Surg. 2016; 401:1241-7.

Senthilnathan P, Chinnusamy P, Ramanujam A, Gurumurthy S, Natesan AV, Chandramaliteeswaran C et al. Comparison of Pathological Radicality between OpeIndian J Surg Oncol. 2015;6(1):20-5.

Waechter FL, Amaral PCG, Costa RM, Rezende MB, Vasques RR, Torres O et al. Pancreatoduodenectomy: Brazilian practice patterns. HPB. 2018;20:160.‏

Wang Y, Bergman S, Piedimonte S, Vanounou T. Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach. Can J Surg. 2014;57(4):263.‏

Frakes J, Mellon EA, Springett G, Hodul P, Malafa MP, Fulp WJ, et al. Outcomes of adjuvant radiotherapy and lymph node resection in elderly patients with pancreatic cancer treated with surgery and chemotherapy. J Gastrointest Oncol. 2017;8(5):758.‏

Wang W, Shen Z, Shi Y, Zou S, Fu N, Jiang Y et al. Accuracy of the nodal positivity of inadequate lymphadenectomy in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A population study of the US SEER database. Front Oncol. 2019;9:1386.‏

Showalter TN, Winter KA, Berger AC, Regine WF, Abrams RA, Safran H et al. The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: a secondary analysis of RTOG 9704. Int J Radiat Oncol Biol Phy. 2011;81(5):1328-35.‏

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Published

2020-12-28

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Original Research Articles