Usefulness of the mesopancreas-first approach using isolating tape in conversion surgery for pancreatic cancer |
| |
| Affiliation: | 1. The Jikei University Kashiwa Hospital, Department of Surgery, Japan;2. The Jikei University School of Medicine, Department of Surgery, Japan;1. Division of Surgical Oncology, The Hiram C. Polk, Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA;2. Department of Pathology, Norton Healthcare, Louisville, KY, 40292, USA;1. Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA;2. Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA;3. Department of Medicine, Washington University, St. Louis, Missouri, USA;4. McMaster University and Hamilton Health Sciences, Department of Surgery, Hamilton, Ontario, Canada;5. Division of Oncology, Washington University, St. Louis, Missouri, USA;6. Siteman Cancer Center, Barnes Jewish Hospital, and Washington University School of Medicine, USA;7. Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA;1. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of General and Visceral Surgery, Campus Benjamin Franklin, Berlin, Germany;2. Sorbonne Université, Department of Digestive Surgery, Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Saint Antoine, Paris, France;3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France;5. Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany;6. Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea;7. Department of Surgery and Department of Internal Medicine and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA;8. Sorbonne Université, Assistance Publique des Hôpitaux de Paris AP-HP, Department of Pathology, Saint-Antoine Hospital, Paris, France;9. Department of Surgery, University Hospital of Bonn, Bonn, Germany;10. Department of Surgery, University Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;11. Department of Experimental and Clinical Medicine, IBD Unit, Careggi University Hospital, Florence, Italy;12. First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece;13. Department of General Surgery, Peking Union Medical College Hospital, Beijing, China;14. Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece;15. Department of Hepato-gastroenterology, CHU Tours, France;p. Department of Digestive, Oncological, Endocrine, Hepato-Biliary and Pancreatic Surgery, Liver Transplantation, Colorectal Surgery Unit, Trousseau Hospital, Tours, France;q. Clinical Research Center, Chiba University Hospital, Chiba, Japan;r. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea |
| |
| Abstract: | BackgroundR0 resection is an important prognostic factor in patients with pancreatic cancer (PC). Advances in chemotherapy have improved the R0 resection rate for unresectable locally advanced (UR-LA) PC. There is a limit to determine on imaging whether R0 resection is possible due to chemotherapy effects. Therefore, we rely on intraoperative frozen section diagnosis (FSD). We devised a mesopancreas-first approach using isolating tape (iTape) to ensure the assessment of resectability before organ dissection.PatientsThe mesopancreas-first approach using iTape was performed in patients with UR-LA PC who were determined to be able to achieve R0 resection by pancreaticoduodenectomy after chemotherapy.MethodsIn this method, the mesopancreas is taped before organ dissection, and subsequent mesopancreas separation is performed by pulling the tape. The iTape is first placed through the retroperitoneal space between the mesopancreas and the inferior vena cava followed by extraction from the common hepatic artery, body of the pancreas, and splenic vein on the cranial side of the pancreas and from the superior mesenteric artery on the caudal side of the pancreas. As a result, the iTape is individually enmeshed in the mesopancreas. This way, only the mesopancreas can be dissected, while sparing other organs and tissues. If R0 resection is judged to be difficult by intraoperative FSD, the procedure is converted into bypass surgery.ConclusionThis method may be useful for pancreaticoduodenectomy in conversion cases and the resectability can be evaluated prior to organ dissection. |
| |
| Keywords: | Conversion surgery Pancreatic cancer Surgical technique |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
