Application value of artery approach in the lower colon region combined with portal vein resection and allograft vascular grafts in radical pancreaticoduodenectomy

Abstract

Objective To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion. Methods The retrospective descriptive study was conducted. The clinicopathological data of 13 patients with pancreatic cancer involving in PV, splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected. The superior mesenteric artery (SMA), tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors. Patients underwent PV-splenic vein resection and reconstruction with allogenic vein. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situations: 13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV, splenic vein resection and allograft vascular grafts. Operation time and volume of intraoperative blood loss were respectively (489±31)minutes and (407±96)mL, without intra- and post- operative deaths. (2) Postoperative situations: of 13 patients, 3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia, and cured by conservative treatment.There was no occurrence of bleeding, intraperitoneal infection, diarrhea, anastomotic stenosis and thrombus. The median duration of postoperative hospital stay was 12 days. Results of postoperative pathological examination: of 13 patients, high-, moderate- and low-differentiated adenocarcinoma was detected in 2, 7 and 4 patients respectively. Three patients had negative vascular margin, 2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One, 2, 6, 4 patients were detected in ⅠB, ⅡA, ⅡB and Ⅲ staging, respectively. The negative margin rate by postoperative pathological examination was 11/13. (3) Follow-up situation: 13 patients were followed up 10 months postoperatively, with good survival and without tumor recurrence or metastasis. Conclusion The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV, splenic vein or junction, it can also evaluate early resectability of tumors, with good operative efficacy. Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Artery approach; Vascular grafts