Kim Seongho, Yoon Yoo-Seok, Han Ho-Seong, Cho Jai Young
Departments of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Departments of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Surg Oncol. 2019 Mar;28:150. doi: 10.1016/j.suronc.2018.12.006. Epub 2019 Jan 3.
Numerous recent studies have reported comparable oncologic outcomes of laparoscopic distal pancreatectomy for pancreatic cancer compared with open surgery [1,2]. Most of these laparoscopic procedures, however, involved resection for left-sided pancreatic cancer where R0 resection was possible by pancreatic transection around the portal vein-superior mesenteric vein with preservation of the gastroduodenal artery (GDA) [3,4]. Here we describe our technique of laparoscopic subtotal pancreatectomy for pancreatic cancer located in the neck of the pancreas, which requires resection of the GDA and radical antegrade modular pancreatosplenectomy (RAMPS) to achieve a clear resection margin.
A pancreatic mass was detected in a 72-year-old female at a routine health check. Abdominal CT revealed a low-attenuating mass of diameter 2 cm located in the neck of the pancreas, close to the GDA. We planned laparoscopic subtotal pancreatectomy with resection of the GDA. Subtotal pancreatectomy near the duodenum was performed after resection of the GDA. Lymph nodes on the left side of the celiac axis and superior mesenteric artery were dissected. Retroperitoneal dissection was performed by anterior RAMPS, exposing the left renal vein and saving the left adrenal gland.
The operative time was 220 minutes and the estimated intraoperative blood loss was 200 mL. All the resection margins were clear. The pathologic staging was pT3N0, and 21 lymph nodes were retrieved. The patient was discharged on postoperative day 7 with no postoperative complications.
Curative resection of left-sided pancreatic cancer can be safely performed by laparoscopic subtotal pancreatectomy with RAMPS.
近期大量研究报告称，与开放手术相比，腹腔镜下远端胰腺癌切除术的肿瘤学结局相当[1,2]。然而，这些腹腔镜手术大多涉及左侧胰腺癌的切除，通过在门静脉-肠系膜上静脉周围横断胰腺并保留胃十二指肠动脉（GDA）可实现R0切除[3,4]。在此，我们描述了针对位于胰颈部的胰腺癌的腹腔镜次全胰腺切除术技术，该手术需要切除GDA并采用根治性顺行模块化胰脾切除术（RAMPS）以获得切缘阴性。
一名72岁女性在常规健康检查中发现胰腺肿物。腹部CT显示一个直径2 cm的低密度肿物位于胰颈部，靠近GDA。我们计划行腹腔镜次全胰腺切除术并切除GDA。在切除GDA后，在十二指肠附近进行了次全胰腺切除术。清扫了腹腔干轴左侧和肠系膜上动脉的淋巴结。通过前入路RAMPS进行腹膜后清扫，暴露左肾静脉并保留左肾上腺。
手术时间为220分钟，估计术中出血量为200 mL。所有切缘均为阴性。病理分期为pT3N0，共清扫出21枚淋巴结。患者术后第7天出院，无术后并发症。
通过腹腔镜次全胰腺切除术联合RAMPS可安全地对左侧胰腺癌进行根治性切除。
