Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
J Gastrointest Surg. 2019 Mar;23(3):613-616. doi: 10.1007/s11605-018-3923-6. Epub 2018 Sep 5.
The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case.
This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula.
This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.
对于广泛水平肿瘤扩散侵犯肝门和胰内胆管的胆管癌，联合进行大肝切除术和胰十二指肠切除术（PD），即肝胰十二指肠切除术（HPD），是唯一的治愈性治疗方法。然而，这种激进的手术方法在生存获益和高死亡率和发病率风险之间存在争议，特别是术后肝功能衰竭和术后胰瘘的风险。在这里，我们描述了一种新的改良 HPD 技术治疗肝门部胆管癌的疗效，重点介绍了手术技术和短期结果，并提供了一个代表性病例。
这种新的手术技术涉及在肿瘤下方和上方所需部分解剖完成后，在最后一步解剖胰腺实质和相关的十二指肠系膜，以便切除切除的标本。本文所述的这种技术可以通过尽可能在后半部分手术过程中解剖胰腺实质来防止胰腺切除面的皂化。结果表明，这种技术与预防术后胰瘘之间可能也存在一定的关系。
通过尽可能延迟术中胰腺实质的解剖，HPD 的这种新手术技术可能能够预防术后胰瘘，从而提高 HPD 的安全性。
