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- Title
Total meso-pancreatoduodenum excision with pancreaticoduodenectomy in lower biliary tract cancer.
- Authors
Kawabata, Yasunari; Hayashi, Hikota; Ishikawa, Noriyoshi; Tajima, Yoshitsugu
- Abstract
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.
- Subjects
BILIARY tract cancer; PANCREATICODUODENECTOMY; SURGICAL excision; MESENTERIC artery; PERIOPERATIVE care; HEALTH outcome assessment; SURGERY; CANCER treatment
- Publication
Langenbeck's Archives of Surgery, 2016, Vol 401, Issue 4, p463
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-016-1435-y