The Efficacy of 17 Cases of Pancreaticoduodenectomy Combined with Vascular Resection and Reconstruction by Using Robotic Operation System (with Video)

YANG Jing-rui, CHEN Meng-min, DENG Xia-xing, QIN Kai, SHI Yu-sheng, ZHANG Jia-qiang, CHENG Dong-feng, JIN Jia-bin, PENG

Abstract

To explore the clinical efficacy of pancreaticoduodenectomy (PD) combined with vascular resection and reconstruction under robotic surgery system in the treatment of borderline resectable pancreatic cancer.  Methods   The clinical data of 17 patients with borderline resectable pancreatic cancer who underwent PD combined with vascular resection and reconstruction (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760202) under robotic surgery system between August 2011 and September 2018 was analyzed retrospectively.  Results  There were 4 cases required conversion because of serious tumor invasion and soft pancreas texture, the other 13 cases were successfully completed. 16 cases (94%) achieved margin-negative resection (R0 resection), 14 cases combined with vein resection, and 3 cases combined with arterial resection. The mean operation time was (401±170) min, the mean blood loss was (647±345) mL, the mean postoperative length of hospital stay was (20±8) d. There was no perioperative death. Postoperative pathology findings and follow-up outcomes were as follows: 1 patient was diagnosed as intraductal papillary mucinous neoplasm (IPMN) and 1 patient was diagnosed as pancreatic neuroendocrine tumors (PNET) (Grade 1), 8 patients with pancreatic ductal adenocarcinoma (PDAC). 1 patient with pancreatic neuroendocrine carcinoma (PNEC) died because of tumor recurrence and metastasis during the follow-up period, the median (Min-Max) survival time was 12 (8-26) months. 5 patients with PDAC and 1 patient with malignant IPMN were currently in the follow-up period.  Conclusion  It is safe and feasible to perform RPD with vascular resection and reconstruction. The patient's condition should be fully evaluated before surgery to select the most appropriate treatment.


Keywords: Borderline resectable pancreatic cancer, Robotic surgery system, Vascular reconstruction, Pancreaticoduodenectomy


Full Text:

PDF


References


BRAY F， FERLAY J， SOERJOMATARAM I， et al. Global cancer statistics 2018: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin，2018，68(6): 394–424.

ILIC M， ILIC I. Epidemiology of pancreatic cancer. World J Gastroenterol，2016，22(44): 9694–9705.

GILLEN S ， SCHUSTER T， BÜSCHENFELDE C M， et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med， 2010， 7(4): e1000267[2019-09-20]. https://doi.org/10.1371/journal. pmed.1000267.

HOWARD T J， KRUG J E， YU J， et al. A margin-negative r0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer. J Gastrointest Surg，2006，10(10): 1338–1346.

VARADHACHARY G R， TAMM E P， ABBRUZZESE J L， et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol，2006，13(8): 1035–1046.

TEMPERO M A， MALAFA M P， AL-HAWARY M， et al. Pancreatic adenocarcinoma， version 2.2017， clinical practice guidelines in oncology. J Natl Compr Canc Netw， 2017， 15(8): 1028[2019-09-20]. https://doi.org/ 10.6004/jnccn.2017.0131. doi: 10.6004/jnccn.2017.0131.

GAGNER A， POMP A. Laparoscopic pylorus-preserving pancreatico-duodenectomy. Surg Endosc，1994，8: 408–410.

CAI Y， GAO P， LI Y， et al. Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc，2018，32: 4209–4215.

AUSANIA F， LANDI F， MARTINEZ-PEREZ A， et al. A meta-analysis of randomized controlled trials comparing laparoscopic vs open pancreaticoduodenectomy. HPB (Oxford)，2019，21(12): 1613–1620.

HILST J， ROOIJ T， BOSSCHA K， et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (leopard-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol，2019，4(3): 199–207.

LEE S H， LIM S， JIN H K， et al. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res，2015，89(4): 190–201.

GIULIANOTTI P C， ADDEO P， BUCHS N C， et al. Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas，2011，40(8): 1264–1270.

MOLLBERG N， RAHBARI N N， KOCH M， et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg，2011，254(6): 882–893.

KASUMOVA G G， CONWAY W C， TSENG J F. The role of venous and arterial resection in pancreatic cancer surgery. Ann Surg Oncol，2018， 25(1): 51–58.


Refbacks

  • There are currently no refbacks.