Optimal Extent of Superior Mesenteric Artery Dissection during Pancreaticoduodenectomy for Pancreatic Cancer: Balancing Surgical and Oncological Safety View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-10-10

AUTHORS

Yosuke Inoue, Akio Saiura, Atsushi Oba, Shoji Kawakatsu, Yoshihiro Ono, Takafumi Sato, Yoshihiro Mise, Takeaki Ishizawa, Yu Takahashi, Hiromichi Ito

ABSTRACT

BackgroundWe describe the short- and long-term outcomes for PDAC patients after tailored mesopancreas dissection using supracolic artery-first approach followed by adjuvant therapy.MethodsThis study analyzed 233 consecutive patients who underwent artery-first pancreaticoduodenectomy for PDAC. Dissection extent for the superior mesenteric artery (SMA) was categorized into three levels: level 2 (LV2) including regional lymph nodes, level 3 (LV3) with hemicircumferential nerve plexus dissection, and extended-level 3 (E-LV3) including borderline resectable cases for the SMA. All clinical, pathological, and survival outcomes were reviewed.ResultsLV2/3/E-LV3 dissection was performed in 77/115/41 patients. The short-term outcomes were similar among groups without mortality. Although postoperative diarrhea requiring opioids was significantly more frequent in the E-LV3 group (76%) than other groups (vs. LV2 (21%), P < .0001; vs. LV3 (34%), P < .0001; LV2 vs. LV3, P = 0.20), most cases of diarrhea were well controlled. Adjuvant chemotherapy was introduced similarly among groups (LV2, 76%; LV3, 81%; E-LV3, 88%, P = 0.29). The 3- and 5-year overall survival rates in the LV2/3/E-LV3 groups were 42/33/42% and 27/22/26%, respectively, showing no significant difference among groups.DiscussionOur tailored dissection and preemptive use of opioid antidiarrheal effectively prevents intractable diarrhea, increasing the success of adjuvant chemotherapy. More... »

PAGES

1373-1383

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11605-018-3995-3

DOI

http://dx.doi.org/10.1007/s11605-018-3995-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1107529106

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30306451


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34 schema:description BackgroundWe describe the short- and long-term outcomes for PDAC patients after tailored mesopancreas dissection using supracolic artery-first approach followed by adjuvant therapy.MethodsThis study analyzed 233 consecutive patients who underwent artery-first pancreaticoduodenectomy for PDAC. Dissection extent for the superior mesenteric artery (SMA) was categorized into three levels: level 2 (LV2) including regional lymph nodes, level 3 (LV3) with hemicircumferential nerve plexus dissection, and extended-level 3 (E-LV3) including borderline resectable cases for the SMA. All clinical, pathological, and survival outcomes were reviewed.ResultsLV2/3/E-LV3 dissection was performed in 77/115/41 patients. The short-term outcomes were similar among groups without mortality. Although postoperative diarrhea requiring opioids was significantly more frequent in the E-LV3 group (76%) than other groups (vs. LV2 (21%), P < .0001; vs. LV3 (34%), P < .0001; LV2 vs. LV3, P = 0.20), most cases of diarrhea were well controlled. Adjuvant chemotherapy was introduced similarly among groups (LV2, 76%; LV3, 81%; E-LV3, 88%, P = 0.29). The 3- and 5-year overall survival rates in the LV2/3/E-LV3 groups were 42/33/42% and 27/22/26%, respectively, showing no significant difference among groups.DiscussionOur tailored dissection and preemptive use of opioid antidiarrheal effectively prevents intractable diarrhea, increasing the success of adjuvant chemotherapy.
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40 schema:keywords BackgroundWe
41 DiscussionOur
42 MethodsThis study
43 PDAC
44 PDAC patients
45 Surgical
46 adjuvant chemotherapy
47 adjuvant therapy
48 antidiarrheal
49 approach
50 artery
51 artery dissection
52 artery-first approach
53 borderline resectable cases
54 cancer
55 cases
56 chemotherapy
57 consecutive patients
58 diarrhea
59 differences
60 dissection
61 dissection extent
62 extent
63 group
64 intractable diarrhea
65 level 2
66 level 3
67 levels
68 long-term outcomes
69 lymph nodes
70 mesenteric artery
71 mesenteric artery dissection
72 mesopancreas dissection
73 mortality
74 most cases
75 nodes
76 oncological safety
77 opioids
78 optimal extent
79 outcomes
80 overall survival rate
81 pancreatic cancer
82 pancreaticoduodenectomy
83 patients
84 postoperative diarrhea
85 preemptive use
86 rate
87 regional lymph nodes
88 resectable cases
89 safety
90 short-term outcomes
91 significant differences
92 study
93 success
94 superior mesenteric artery
95 superior mesenteric artery dissection
96 survival outcomes
97 survival rate
98 therapy
99 use
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