Perioperative Outcome of Systematic Mesopancreas Dissection for Pancreatic and Periampullary Carcinoma at a Tertiary Referral Centre from a Low-middle Income Country

Abstract

Purpose: Margin negative resection is considered as the surrogate marker of quality surgery. However, in pancreatic cancer the incidence of R1 resection is high despite of a very good quality surgery. Total mesopancreas excision has been considered to improve the margin negative resection and the lymph node yield. Amongst various techniques of mesopancreas excision (SMD), systematic mesopancreas dissection is applicable to pancreatic as well as other periampullary carcinoma. Objective: This study has been done to compare the perioperative outcomes, the lymph node yield and the margin status in patients who undergo standard pancreaticoduodenectomy (ST-PD) and SMD pancreaticoduodenectomy (SMD-PD) for pancreatic and periampullary carcinoma. Methods: A retrospective comparative study was conducted in patients who underwent pancreaticoduodenectomy for pancreatic and periampullary carcinoma in a single unit of Gastrointestinal and Hepatopancreatobiliary surgery at Tribhuvan University Teaching Hospital, Nepal. The demographics, indication of surgery, duration of surgery, intraoperative blood loss, incidence of procedure-specific complications as defined by International study group on pancreatic surgery (ISGPS), length of hospital stay, perioperative mortality, stage of the disease, lymph node yield and margin status were compared between the SMD-PD and ST-PD. Results: Total of 33 patients underwent SMD-PD with the mean age of 56.7 ± 12.9 years with 63.6% of patients being male. The most common indication of surgery was ampullary carcinoma. The demographic data was comparable with the historical data of 45 patients who underwent ST-PD. The duration of surgery (344.2±48.6 mins vs 374.2 ± 54.9 mins) and intraoperative blood loss (436.4 ± 171.3 ml vs 481.8 ± 196.4 ml) was found to be comparable with the patients who underwent SMD-PD. However, the incidence of postoperative pancreatic fistula and perioperative mortality were less in patients who underwent SMD-PD as compared to the patients who underwent ST-PD (21.2% vs 26.7% and 9.1% vs 11.1% respectively). The rate of margin negative resection was high (97% vs 91.1%). The median lymph node yield was significantly high in patients who underwent SMD-PD (15 vs 6, p < 0.05). Conclusion: SMD-PD is feasible and should be done not only for pancreatic carcinoma but also for other periampullary carcinoma.