Vallance Abigail E, Young Alastair L, Pandanaboyana Sanjay, Lodge Jeremy Peter, Smith Andrew M
From the *Department of Pancreatic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK; and †Department of HPB Surgery, Auckland City Hospital, Auckland, New Zealand.
Pancreas. 2017 Feb;46(2):276-281. doi: 10.1097/MPA.0000000000000748.
Posterior superior mesenteric artery (SMA) first dissection in pancreaticoduodenectomy (PD) may allow for early assessment of resectability and aberrant anatomy. Study objectives were to compare resection margins, perioperative outcomes, disease-free survival (DFS) and overall survival (OS) in patients undergoing a posterior SMA first dissection PD to a classical technique PD.
Patients (n = 77) who underwent a posterior SMA first PD for adenocarcinoma were case matched for patient and tumor characteristics with patients undergoing a classical approach PD from 2006 to 2014 (n = 177).
The SMA first patients had an improved negative resection margin rate (27 [35.1%] vs 14 [18.2%], P = 0.042) and a higher lymph node yield (median 28 [22-34] vs 21 [17-27], P < 0.001) compared with the classical approach group. No difference was demonstrated in serious complications or 30-day mortality between the SMA first and classical approach patients (Clavien-Dindo 3/4 16 [20.8%] vs 11 [14.3%], P = 0.336; 30-day mortality 3 [3.9%] vs 3 [3.9%], P = 1.00 respectively). Median DFS and OS was similar in SMA first compared with classical approach patients (DFS, 1.6 vs 1.1 years, P = 0.122; OS, 2.5 vs 1.5 years, P = 0.220 respectively).
A posterior SMA first approach is a comparably safe technique that may improve oncological results in PD compared with classical approach dissection.
在胰十二指肠切除术（PD）中先进行肠系膜上动脉（SMA）后方解剖，可能有助于早期评估可切除性及异常解剖结构。本研究的目的是比较先进行SMA后方解剖的PD患者与采用传统技术的PD患者的切缘、围手术期结局、无病生存期（DFS）和总生存期（OS）。
2006年至2014年，对因腺癌接受SMA后方优先PD的患者（n = 77），按患者和肿瘤特征与接受传统方法PD的患者进行病例匹配（n = 177）。
与传统方法组相比，SMA优先解剖的患者阴性切缘率更高（27例[35.1%]对14例[18.2%]，P = 0.042），淋巴结获取量更多（中位数28个[22 - 34个]对21个[17 - 27个]，P < 0.001）。SMA优先解剖组与传统方法组在严重并发症或30天死亡率方面无差异（Clavien - Dindo 3/4级：16例[20.8%]对11例[14.3%]，P = 0.336；30天死亡率：3例[3.9%]对3例[3.9%]，P = 1.00）。与传统方法组患者相比，SMA优先解剖组患者的DFS和OS中位数相似（DFS，1.6年对1.1年，P = 0.122；OS，2.5年对1.5年，P = 0.220）。
与传统方法解剖相比，先进行SMA后方解剖是一种相对安全的技术，可能改善PD的肿瘤学结局。
