Application value of total mesopancreas excision in radical resection of pancreatic head cancer

doi:10.3877/cma.j.issn.2095-3232.2024.05.011

Abstract

Abstract:

Objective

To evaluate the application value of total mesopancreas excision (TMpE) in radical resection of pancreatic head cancer.

Methods

Clinical data of 78 patients with pancreatic head cancer who underwent pancreaticoduodenectomy (PD) in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2018 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the PD-TMpE group and standard PD group according to surgical methods. 37 patients were assigned into the PD-TMpE group, 33 male and 4 female, aged from 31 to 74 years, with a median age of 58 years. 41 cases were divided into the standard PD group, 31 male and 10 female, aged from 28 to 80 years, with a median age of 59 years. Perioperative indexes including operation time, R0 resection rate, number of dissected lymph nodes, number of positive lymph nodes, incidence of postoperative complications, recurrence time and recurrence type were statistically compared between two groups. Operation time between two groups was compared by t test. The rates between two groups was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The average operation time in the PD-TMpE and standard PD groups was respectively (367±70) and (392±76) min, and the difference was not statistically significant (t=-1.540, P>0.05). The R0 resection rate in the PD-TMpE group was 92%(34/37), significantly higher than 73%(30/41) in the standard PD group (χ²=4.330, P<0.05). In the PD-TMpE group, the 1-year tumor recurrence rate was 16%(6/37), significantly lower than 39%(16/41) in the standard PD group (χ²=4.996, P<0.05). In the PD-TMpE group, the median recurrence-free survival was 17.9 months (95%CI: 15.05-20.73), significantly longer than 13.1 months (95%CI: 13.30-17.47) in the standard PD group (χ²=3.911, P<0.05).

Conclusions

TMpE is a safe, efficacious and feasible surgical approach for pancreatic head cancer, which can improve the R0 resection rate and reduce early recurrence rate without increasing the risk of surgery.

Key words: Pancreaticoduodenectomy, Total mesopancreas excision, Pancreatic neoplasms, Postoperative complications

Liuping Luo, Mengmeng Wu, Xinlei Chen, Kecan Lin. Application value of total mesopancreas excision in radical resection of pancreatic head cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 651-656.

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Figures/Tables 4

References 21

[1]	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1):7-33.
[2]	Fatima J, Schnelldorfer T, Barton J, et al. Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival[J]. Arch Surg, 2010, 145(2):167-172.
[3]	Gaedcke J, Gunawan B, Grade M, et al. The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials[J]. Langenbecks Arch Surg, 2010, 395(4):451-458.
[4]	Hishinuma S, Ogata Y, Tomikawa M, et al. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings[J]. J Gastrointest Surg, 2006, 10(4):511-518.
[5]	Gockel I, Domeyer M, Wolloscheck T, et al. Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space[J]. World J Surg Oncol, 2007, 5:44.
[6]	Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors[J]. Eur J Surg Oncol, 2012, 38(4):340-345.
[7]	Tol JAMG, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS)[J]. Surgery, 2014, 156(3):591-600.
[8]	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Ann Surg, 2009, 250(2):187-196.
[9]	白雪莉, 马涛, 梁廷波. 美国癌症联合委员会第8版胰腺癌分期系统更新简介及解读[J]. 中国实用外科杂志, 2017, 37(2):146-148.
[10]	Wellner UF, Krauss T, Csanadi A, et al. Mesopancreatic stromal clearance defines curative resection of pancreatic head cancer and can be predicted preoperatively by radiologic parameters: a retrospective study[J]. Medicine, 2016, 95(3):e2529.
[11]	刘颖斌, 李永盛, 王许安. 全系膜切除理念在胰头癌根治术中的应用与研究进展[J]. 腹部外科, 2019, 32(5):315-318, 323.
[12]	Liang HB, Wu WG, Li ML, et al. Application of three-dimensional visualization technique in total mesopancreas excision (TMp E) for pancreatic head carcinoma[J]. Chin J Pract Surg, 2019, 39(1):92-95.
[13]	刘成彪, 崔世昌, 王维山, 等. 纳米碳示踪技术在胰头癌行全胰腺系膜切除的胰十二指肠切除中的应用[J]. 解放军医学院学报, 2018, 39(3):185-188, 195.
[14]	Peparini N. Total mesopancreas excision is the better staging tool of the mesopancreas in pancreatic head carcinoma[J]. World J Gastrointest Surg, 2022, 14(7):720-722.
[15]	Aimoto T, Mizutani S, Kawano Y, et al. Left posterior approach pancreaticoduodenectomy with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery for pancreatic head carcinoma[J]. Nippon Ika Daigaku Zasshi, 2013, 80(6):438-445.
[16]	Dumitrascu T, David L, Popescu I. Posterior versus standard approach in pancreatoduodenectomy: a case-match study[J]. Langenbecks Arch Surg, 2010, 395(6):677-684.
[17]	Kurosaki I, Minagawa M, Takano K, et al. Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head[J]. JOP, 2011, 12(3):220-229.
[18]	Kawabata Y, Tanaka T, Nishi T, et al. Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma[J]. Eur J Surg Oncol, 2012, 38(7):574-579.
[19]	Xu J, Tian X, Chen Y, et al. Total mesopancreas excision for the treatment of pancreatic head cancer[J]. J Cancer, 2017, 8(17):3575-3584.
[20]	徐云柯, 苏松, 淦宇, 等. 胰腺全系膜切除的胰十二指肠切除术治疗壶腹周围癌及胰头癌的安全性及疗效分析[J]. 中国普外基础与临床杂志, 2018, 25(12):1464-1468.
[21]	Feng P, Cheng B, Wang ZD, et al. Application and progress of medical imaging in total mesopancreas excision for pancreatic head carcinoma[J]. World J Gastrointest Surg, 2021, 13(11):1315-1326.

组别	例数（例）	性别（例）		年龄（岁，±s）	BMI（kg/m²，±s）	TB[μmol/L，M（Q₁，Q₃）]	DB [μmol/L，M（Q₁，Q₃）]	CA19-9[kU/L，M（Q₁，Q₃）]	CA125[kU/L，M（Q₁，Q₃）]	肿瘤直径（cm，±s）	TNM分期（例）
组别	例数（例）	男	女	年龄（岁，±s）	BMI（kg/m²，±s）	TB[μmol/L，M（Q₁，Q₃）]	DB [μmol/L，M（Q₁，Q₃）]	CA19-9[kU/L，M（Q₁，Q₃）]	CA125[kU/L，M（Q₁，Q₃）]	肿瘤直径（cm，±s）	Ⅰ	Ⅱ	Ⅲ
PD-TMpE组	37	20	17	58±10	22.3±2.9	144（22，188）	79（8，107）	66（33，162）	13（10，17）	2.5±1.0	14	6	17
标准PD组	41	31	10	59±11	22.8±3.1	147（51，195）	85（31，110）	160（34，363）	15（10，23）	2.5±0.9	11	5	25
统计值		χ²=3.010		t=-0.380	t=-0.640	Z=-0.655	Z=-0.590	Z=-1.407	Z=-0.596	t<0.001	χ²=1.770
P值		0.080		0.702	0.526	0.512	0.555	0.159	0.551	>0.999	0.410

组别	例数（例）	性别（例）		年龄（岁，±s）	BMI（kg/m²，±s）	TB[μmol/L，M（Q₁，Q₃）]	DB [μmol/L，M（Q₁，Q₃）]	CA19-9[kU/L，M（Q₁，Q₃）]	CA125[kU/L，M（Q₁，Q₃）]	肿瘤直径（cm，±s）	TNM分期（例）
组别	例数（例）	男	女	年龄（岁，±s）	BMI（kg/m²，±s）	TB[μmol/L，M（Q₁，Q₃）]	DB [μmol/L，M（Q₁，Q₃）]	CA19-9[kU/L，M（Q₁，Q₃）]	CA125[kU/L，M（Q₁，Q₃）]	肿瘤直径（cm，±s）	Ⅰ	Ⅱ	Ⅲ
PD-TMpE组	37	20	17	58±10	22.3±2.9	144（22，188）	79（8，107）	66（33，162）	13（10，17）	2.5±1.0	14	6	17
标准PD组	41	31	10	59±11	22.8±3.1	147（51，195）	85（31，110）	160（34，363）	15（10，23）	2.5±0.9	11	5	25
统计值		χ²=3.010		t=-0.380	t=-0.640	Z=-0.655	Z=-0.590	Z=-1.407	Z=-0.596	t<0.001	χ²=1.770
P值		0.080		0.702	0.526	0.512	0.555	0.159	0.551	>0.999	0.410

组别	例数（例）	手术时间（min，±s）	术中出血量[ml，M（Q₁，Q₃）]	住院时间[d，M（Q₁，Q₃）]	淋巴结清扫数目[个，M（Q₁，Q₃）]	淋巴结阳性数目[个，M（Q₁，Q₃）]
PD-TMpE组	37	367±70	150（100，300）	39（28，54）	21（16，26）	1（0，3）
标准PD组	41	392±76	200（100，400）	35（31，43）	22（17，30）	1（0，2）
统计值		t=-1.540	Z=1.521	Z=0.616	Z=-1.197	Z=0.080
P值		0.128	0.128	0.538	0.231	0.935
组别	例数（例）	血管重建（例）	R0切除（例）	并发症（例）	Clavien Ⅰ～Ⅱ（例）	Clavien Ⅲ～Ⅳ（例）	术后辅助治疗（例）
PD-TMpE组	37	3	34	15	9	6	26
标准PD组	41	0	29	17	10	7	24
统计值		-	χ²=4.330	χ²<0.001	χ²<0.001	χ²<0.001	χ²=0.710
P值		0.200	0.038	>0.999	>0.999	>0.999	0.400

组别	例数（例）	手术时间（min，±s）	术中出血量[ml，M（Q₁，Q₃）]	住院时间[d，M（Q₁，Q₃）]	淋巴结清扫数目[个，M（Q₁，Q₃）]	淋巴结阳性数目[个，M（Q₁，Q₃）]
PD-TMpE组	37	367±70	150（100，300）	39（28，54）	21（16，26）	1（0，3）
标准PD组	41	392±76	200（100，400）	35（31，43）	22（17，30）	1（0，2）
统计值		t=-1.540	Z=1.521	Z=0.616	Z=-1.197	Z=0.080
P值		0.128	0.128	0.538	0.231	0.935
组别	例数（例）	血管重建（例）	R0切除（例）	并发症（例）	Clavien Ⅰ～Ⅱ（例）	Clavien Ⅲ～Ⅳ（例）	术后辅助治疗（例）
PD-TMpE组	37	3	34	15	9	6	26
标准PD组	41	0	29	17	10	7	24
统计值		-	χ²=4.330	χ²<0.001	χ²<0.001	χ²<0.001	χ²=0.710
P值		0.200	0.038	>0.999	>0.999	>0.999	0.400

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