Triangle Operation: Our Early Experience

Abstract

Introduction: The triangle tissue bounded by superior mesenteric artery (SMA), common hepatic artery (CHA), and portal vein (PV) is dissected while performing the vessel-oriented approach of pancreatoduodenectomy (PD) “the TRIANGLE operation”. This study aims to reveal the status of tumor positivity of the tissue at the angle between the confluence of SMA and coeliac trunk (CT), a common site of recurrence, in relation to the tumor positivity of tissue in the rest of the TRIANGLE. Method: This is a hospital-based prospective cross-sectional study conducted from September 2020 to February 2021. All consecutive patients subjected for PD for pancreatic malignancy were included. Triangle operation was performed in all these cases and the tissue at the angle between SMA and CT (tA) and the rest of the triangle (tR) were sent separately for histopathological examination. Results: 27 patients underwent the “TRIANGLE” operation during the period. Median age 65 ± 13.34 years (range 32–84 years). Median preoperative BMI 21.75± 2.5. In 20 patients both tA and tR were negative for tumor suggesting R0 resection. In 3 patients tA was negative but tR was positive, the other 4 patients had both tA and tR positive status. Morbidity (Clavien–Dindo grade 2or more) was noted in 8 patients with 1 mortality. Conclusions: Extensive tissue dissection during TRIANGLE operation helps to achieve R0 resection without significant short-term morbidity. Long-term result awaited.