医学
围手术期
解剖(医学)
新辅助治疗
外科
肠系膜上动脉
胰腺癌
肠系膜下动脉
放射科
根治性手术
癌症
内科学
乳腺癌
作者
Thilo Hackert,Oliver Strobel,Christoph Michalski,André L. Mihaljevic,Arianeb Mehrabi,Beat P. Müller‐Stich,Christoph Berchtold,Alexis Ulrich,Markus W. Büchler
出处
期刊:Hpb
[Elsevier]
日期:2017-11-01
卷期号:19 (11): 1001-1007
被引量:140
标识
DOI:10.1016/j.hpb.2017.07.007
摘要
BackgroundNeoadjuvant therapy is an important strategy for locally advanced pancreatic cancer (PDAC) as resection rates increase with modern chemotherapy regimens even in patients with arterial tumor encasement. The aim of this study is the description of technique and initial outcomes of a new type of radical and arterial-sparing resection after neoadjuvant treatment for locally advanced PDAC.MethodsThe surgical technique and perioperative results of a new type of operation are described, comprising radical tumor removal by sharp dissection along the celiac axis and the superior mesenteric artery with complete dissection of all soft tissue between both – arteries and superior mesenteric/portal vein (TRIANGLE operation).Results15 patients underwent artery-preserving tumor removal without mortality, 7/15 patients showed postoperative complications and an R0 resection was achieved in 6/15 patients. Functional outcome was good in 11/15 patients despite the extended approach of dissection.ConclusionAfter neoadjuvant therapy for locally advanced PDAC, surgical exploration should be attempted in patients with stable disease or remission to clarify true vascular infiltration. In case of absent viable tumor, the described technique allows to perform radical surgery without arterial resection in this subgroup of patients.
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