Total meso-pancreatoduodenum excision with pancreaticoduodenectomy in lower biliary tract cancer

Background Incomplete tumor resection with insufficient lymphadenectomy following a pancreaticoduodenectomy (PD) for lower biliary tract cancer results in a dismal outcome. This study aimed to compare the short-term outcomes of PD between total meso-pancreatoduodenum excision (tMPDe) and the convent...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2016-06, Vol.401 (4), p.463-469
Main Authors: Kawabata, Yasunari, Hayashi, Hikota, Ishikawa, Noriyoshi, Tajima, Yoshitsugu
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Aged, 80 and over
Biliary Tract Neoplasms - mortality
Biliary Tract Neoplasms - pathology
Biliary Tract Neoplasms - surgery
Cardiac Surgery
Female
General Surgery
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Original Article
Pancreaticoduodenectomy
Retrospective Studies
Survival Rate
Thoracic Surgery
Traumatic Surgery
Treatment Outcome
Vascular Surgery
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Summary:Background Incomplete tumor resection with insufficient lymphadenectomy following a pancreaticoduodenectomy (PD) for lower biliary tract cancer results in a dismal outcome. This study aimed to compare the short-term outcomes of PD between total meso-pancreatoduodenum excision (tMPDe) and the conventional procedure for lower biliary tract cancer. Methods Patients who underwent PD for lower biliary tract cancer between May 2003 and March 2015 were included in this study. We have devised a new surgical technique, tMPDe, as a mesenteric plane surgery with an artery-first approach, for achieving complete clearance of the peripancreatic retroperitoneal tissue and lymph nodes. Perioperative data, including complications and short-term survival, were evaluated. Results A total of 74 consecutive patients underwent a PD: 41 patients underwent conventional PD (cPD), and 33 underwent tMPDe. The tumor stages were similar in the two study groups. R0 was achieved in 32 patients (78.0 %) with cPD and in 31 patients (93.9 %) with tMPDe ( p  = 0.046). The survival rates at 1 and 3 years after surgery were 82.5 and 64.0 % for the cPD group, with a median follow-up period of 44.6 months, and 92.8 and 84.4 % for the tMPDe group, with a median follow-up period of 28.6 months, respectively. Conclusions The tMPDe technique significantly increased R0 resection and contributed to better oncological outcomes in lower biliary tract cancer.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-016-1435-y