Skip to main content
Erschienen in: Surgical Endoscopy 12/2020

04.08.2020 | Dynamic Manuscript

3D-laparoscopic pancreaticoduodenectomy with superior mesenteric or portal vein resection for pancreatic cancer

verfasst von: Joachim Geers, Halit Topal, Joris Jaekers, Baki Topal

Erschienen in: Surgical Endoscopy | Ausgabe 12/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Minimally invasive pancreaticoduodenectomy with synchronous vein resection for pancreatic cancer is controversial. The aim of this study was to evaluate outcomes and describe the surgical technique of 3d-laparoscopic pylorus-resecting pancreaticoduodenectomy (3dLPD) with venous resection for pancreatic cancer.

Methods

A retrospective cohort analysis was performed with 26 patients [male/female 11/15; median age 68 (range 45–83) years] who underwent 3dLPD with stented pancreaticogastrostomy and superior mesenteric or portal vein resection for pancreatic adenocarcinoma between November 2016 and June 2019. Median follow-up time after surgery was 12 months (range 3–32).

Results

Median operating time was 340 min (range 240–420) and intra-operative blood loss was 100 mL (range 0–1000). Type of venous resection and reconstruction was wedge-resection with primary closure (n = 22), wedge-resection with reconstruction using a peritoneal patch (n = 3), and segmental resection with primary end-to-end reconstruction (n = 1). Laparoscopy was converted to open surgery in 4 (15%) patients. Postoperative complications occurred in 10 (38%) patients including severe complications (Clavien–Dindo grade > 2) in 4 (15%). Postoperative mortality was zero. R0 resection was achieved in 21 (81%) patients. Median number of lymph nodes retrieved was 25 (range 10–45). Venous patency was observed in 23 (88%) patients with a median patency duration of 11 months (range 0–31).

Conclusions

3dLPD with simultaneous venous resection for pancreatic cancer results in acceptable reconstruction patency and adequacy of surgical oncology without compromising clinical outcomes.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhut A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988CrossRef Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhut A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988CrossRef
2.
Zurück zum Zitat Barreto S, Windsor J (2016) Justifying vein resection with pancreatoduodenectomy. Lancet Oncol 17:e118–e124CrossRef Barreto S, Windsor J (2016) Justifying vein resection with pancreatoduodenectomy. Lancet Oncol 17:e118–e124CrossRef
3.
Zurück zum Zitat Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, Van Laethem JL, Conroy T, Arnold D (2015) Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(suppl 5):v56–v68CrossRef Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, Van Laethem JL, Conroy T, Arnold D (2015) Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(suppl 5):v56–v68CrossRef
4.
Zurück zum Zitat Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310:1473–1481CrossRef Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310:1473–1481CrossRef
6.
Zurück zum Zitat de Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Bush OR, Lips DJ, Festen S, Besselink MG (2016) Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 264(2):257–267CrossRef de Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Bush OR, Lips DJ, Festen S, Besselink MG (2016) Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 264(2):257–267CrossRef
7.
Zurück zum Zitat Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han H-S, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou Y-P, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang S-E, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Abu Hilal M, Besselink MG (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271(1):1–14CrossRef Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han H-S, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou Y-P, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang S-E, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Abu Hilal M, Besselink MG (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271(1):1–14CrossRef
8.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:214–215CrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:214–215CrossRef
9.
Zurück zum Zitat Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH)—an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRef Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH)—an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRef
10.
Zurück zum Zitat Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler MW (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler MW (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef
11.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRef Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768CrossRef
12.
Zurück zum Zitat Kendrick ML, Sclabas GM (2011) Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford) 13(7):454–458CrossRef Kendrick ML, Sclabas GM (2011) Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford) 13(7):454–458CrossRef
13.
Zurück zum Zitat Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM (2011) Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas 40(8):1264–1270CrossRef Giulianotti PC, Addeo P, Buchs NC, Ayloo SM, Bianco FM (2011) Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas 40(8):1264–1270CrossRef
14.
Zurück zum Zitat Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagory DM, Kendrick ML (2015) Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 19(1):189–194CrossRef Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagory DM, Kendrick ML (2015) Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 19(1):189–194CrossRef
15.
Zurück zum Zitat Palanisamy S, Deuri B, Naidu SB, Palanisamy NV, Natesan AN, Palanivelu PR, Parthasarathy R, Palanivelu C (2015) Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: one step forward. Asian J Endosc Surg 8(4):468–472CrossRef Palanisamy S, Deuri B, Naidu SB, Palanisamy NV, Natesan AN, Palanivelu PR, Parthasarathy R, Palanivelu C (2015) Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: one step forward. Asian J Endosc Surg 8(4):468–472CrossRef
16.
Zurück zum Zitat Kauffmann E, Napoli N, Menonna F, Vistoli F, Amorese G, Campani D, Pollina LE, Funel N, Cappelli C, Caramella D, Boggi U (2016) Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 401(8):1111–1122CrossRef Kauffmann E, Napoli N, Menonna F, Vistoli F, Amorese G, Campani D, Pollina LE, Funel N, Cappelli C, Caramella D, Boggi U (2016) Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 401(8):1111–1122CrossRef
17.
Zurück zum Zitat Khatkov IE, Izrailov RE, Khisamov AA, Tyutyunnik PS, Fingerhut A (2017) Superior mesenteric–portal vein resection during laparoscopic pancreatoduodenectomy. Surg Endosc 31(3):1488–1495CrossRef Khatkov IE, Izrailov RE, Khisamov AA, Tyutyunnik PS, Fingerhut A (2017) Superior mesenteric–portal vein resection during laparoscopic pancreatoduodenectomy. Surg Endosc 31(3):1488–1495CrossRef
18.
Zurück zum Zitat Dokmak S, Aussilhou B, Calmels M, Maghrebi H, Ftériche FS, Soubrane O, Sauvanet A (2018) Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament. Surg Endosc 32(7):3256–3261CrossRef Dokmak S, Aussilhou B, Calmels M, Maghrebi H, Ftériche FS, Soubrane O, Sauvanet A (2018) Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament. Surg Endosc 32(7):3256–3261CrossRef
19.
Zurück zum Zitat Cai Y, Gao P, Li Y, Wang X, Peng B (2018) Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc 32(10):4209–4215CrossRef Cai Y, Gao P, Li Y, Wang X, Peng B (2018) Laparoscopic pancreaticoduodenectomy with major venous resection and reconstruction: anterior superior mesenteric artery first approach. Surg Endosc 32(10):4209–4215CrossRef
20.
Zurück zum Zitat Park H, Kang I, Kang CM (2018) Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure? Ann Hepatobilibary Pancreat Surg 22(4):419–424CrossRef Park H, Kang I, Kang CM (2018) Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure? Ann Hepatobilibary Pancreat Surg 22(4):419–424CrossRef
21.
Zurück zum Zitat Allan BJ, Novak SM, Hogg ME, Zeh HJ (2018) Robotic vascular resections during Whipple procedure. J Vis Surg 4(1):13CrossRef Allan BJ, Novak SM, Hogg ME, Zeh HJ (2018) Robotic vascular resections during Whipple procedure. J Vis Surg 4(1):13CrossRef
22.
Zurück zum Zitat Wang X, Cai Y, Zhao W, Gao P, Li Y, Liu X, Peng B (2019) Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft. Medicine (Baltimore) 98(3):e14204CrossRef Wang X, Cai Y, Zhao W, Gao P, Li Y, Liu X, Peng B (2019) Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft. Medicine (Baltimore) 98(3):e14204CrossRef
23.
Zurück zum Zitat Beane J, Zenati M, Hamad A, Hogg ME, Zeh HJ 3rd, Zureikat AH (2019) Robotic pancreatoduodenectomy with vascular resection: outcomes and learning curve. Surgery 166(1):8–14CrossRef Beane J, Zenati M, Hamad A, Hogg ME, Zeh HJ 3rd, Zureikat AH (2019) Robotic pancreatoduodenectomy with vascular resection: outcomes and learning curve. Surgery 166(1):8–14CrossRef
24.
Zurück zum Zitat Chandrasegaram MD, Goldstein D, Simes J, Gebski V, Kench JG, Gill AJ, Samra JS, Merrett ND, Richardson AJ, Barbour AP (2015) Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. Br J Surg 102(12):1459–1472CrossRef Chandrasegaram MD, Goldstein D, Simes J, Gebski V, Kench JG, Gill AJ, Samra JS, Merrett ND, Richardson AJ, Barbour AP (2015) Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. Br J Surg 102(12):1459–1472CrossRef
25.
Zurück zum Zitat Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93(10):1232–1237CrossRef Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93(10):1232–1237CrossRef
26.
Zurück zum Zitat Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfield C, Jäger D, Schirmacher P, Hackert T, Büchler MW (2017) Pancreatic cancer surgery: the new R-status counts. Ann Surg 265(3):565–573CrossRef Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfield C, Jäger D, Schirmacher P, Hackert T, Büchler MW (2017) Pancreatic cancer surgery: the new R-status counts. Ann Surg 265(3):565–573CrossRef
Metadaten
Titel
3D-laparoscopic pancreaticoduodenectomy with superior mesenteric or portal vein resection for pancreatic cancer
verfasst von
Joachim Geers
Halit Topal
Joris Jaekers
Baki Topal
Publikationsdatum
04.08.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 12/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07847-3

Weitere Artikel der Ausgabe 12/2020

Surgical Endoscopy 12/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.