Detailed Abstract
[BP Video Exhibition - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP VE 12] Artery first and total mesopancreas excision for pancreatic ductal adenocarcinoma
Orlando TORRES1, Eduardo FERNANDES1, Jose Maria MORAES-JUNIOR1
1Department of Liver Transplantation and Hepatobiliary Surgery, Presidente Dutra University Hospital, Brazil
Background : The prognosis after pancreatoduodenectomy for pancreatic ductal adenocarcinoma is poor, with 5-year and median survival rates of 20–25% and between 12 and 22 months, respectively. Survival after resection is significantly higher than that in patients with unresected localized disease, and pathological parameters have an impact on survival after resection of pancreatic ductal adenocarcinoma, including lymph node status, extent of lymph node involvement, tumor grade, and perineural invasion. This mesopancreas is by far the most frequent positive site of recurrence after pancreatoduodenectomy associated or not with involvement of the SMV or the pancreatic transection margin. Complete clearance of this region may decrease the recurrence rate after pancreatic resection. The aim of this study is to present technical aspects of "artery first approach" and "total mesopancreas excision" for patients with pancreatic ductal adenocarcinoma with and without vascular resection (with videos).
Methods : Artery first is defined as early control of the SMA and dissection at the SMA margin, at the initial stage of resection, with the aims of identifying arterial tumor infiltration and assessing resectability, promoting adequate clearance of the right side of the SMA, performing radical lymphadenectomy, and minimizing bleeding by ligation of the IPDA. Three types of artery first (right posterior approach, mesenteric approach and right/medial uncinate approach) are presented (with videos).
Results : The dvantages of the artery-first approach are resection without breaching the tumor extension plane, increases R0 resection, complete resection of peripancreatic retroperitoneal tissue around the plexuses, increased lymph nodal clearance, early assessment of non-resectability (SMA involvement), better delineation of SMA and identification of RHA anomalies, easier en bloc resection and reconstruction of SMV-PV, reduced need for graft substitutions and reduced operative time and blood loss (early ligation of IPDA/JA1).
Conclusions : Artery first approach and total mesopancreas excision should the standard of care for patients with pancreatic ductal adenocarcinoma.
Methods : Artery first is defined as early control of the SMA and dissection at the SMA margin, at the initial stage of resection, with the aims of identifying arterial tumor infiltration and assessing resectability, promoting adequate clearance of the right side of the SMA, performing radical lymphadenectomy, and minimizing bleeding by ligation of the IPDA. Three types of artery first (right posterior approach, mesenteric approach and right/medial uncinate approach) are presented (with videos).
Results : The dvantages of the artery-first approach are resection without breaching the tumor extension plane, increases R0 resection, complete resection of peripancreatic retroperitoneal tissue around the plexuses, increased lymph nodal clearance, early assessment of non-resectability (SMA involvement), better delineation of SMA and identification of RHA anomalies, easier en bloc resection and reconstruction of SMV-PV, reduced need for graft substitutions and reduced operative time and blood loss (early ligation of IPDA/JA1).
Conclusions : Artery first approach and total mesopancreas excision should the standard of care for patients with pancreatic ductal adenocarcinoma.
SESSION
BP Video Exhibition
Video Exhibition 3/21/2024 12:00 AM - 12:00 AM