Kiguchi Gozo, Sugioka Atsushi, Kojima Masayuki, Uyama Ichiro
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Surg Oncol. 2019 Mar;28:86-87. doi: 10.1016/j.suronc.2018.11.015. Epub 2018 Nov 19.
Distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) for borderline resectable pancreatic body cancer is increasingly being performed [1,2]. For survival benefits, obtaining margin-free resection (R0 resection) is crucial [3]. However, in patients with cancer abutting the root of the celiac axis and/or SMA, accurate resectability using preoperative imaging is difficult to judge [4]. Recently, we developed a novel strategy named "Retlap: Retroperitoneal-first laparoscopic approach" to achieve accurate evaluation of resectability and minimal invasiveness for difficult hepatopancreatobiliary malignancies and retroperitoneal tumors. Retlap enables direct evaluation of invasion of the roots of the celiac axis and SMA through the retroperitoneal approach.
This video demonstrates the case of a 50-year-old man with a 47 × 36-mm pancreatic body tumor after chemoradiotherapy. Preoperative computed tomography revealed tumor abutting on the roots of the celiac axis and SMA. Changes in the surrounding tissues due to chemoradiotherapy prevented accurate determination of the tumor invasion extent via preoperative imaging; thus, Retlap was applied. Retlap enabled us to identify and secure the roots of the celiac axis and SMA easily despite the advanced tumor. After confirming resectability, DP-CAR was performed.
The operative time and estimated blood loss were 841 min and 572 mL. A negative surgical margin using Retlap was confirmed in frozen sections and R0 resection was achieved with uneventful postoperative course.
Retlap was technically feasible and useful for achieving accurate evaluation of resectability and minimal invasiveness for DP-CAR. Retlap can help provide optimal outcomes in locally advanced pancreatic cancer cases.
对于边界可切除的胰体癌，采用整块切除腹腔干的远端胰腺切除术（DP-CAR）的手术越来越多[1,2]。为了获得生存益处，实现切缘阴性切除（R0切除）至关重要[3]。然而，对于癌灶紧邻腹腔干根部和/或肠系膜上动脉（SMA）的患者，利用术前影像学检查准确判断可切除性很困难[4]。最近，我们开发了一种名为“Retlap：腹膜后优先腹腔镜入路”的新策略，以实现对困难的肝胆胰恶性肿瘤和腹膜后肿瘤的可切除性进行准确评估并实现微创。Retlap能够通过腹膜后入路直接评估腹腔干根部和SMA的侵犯情况。
本视频展示了一名50岁男性的病例，该患者在放化疗后患有一个47×36毫米的胰体肿瘤。术前计算机断层扫描显示肿瘤紧邻腹腔干根部和SMA。放化疗导致的周围组织变化使得无法通过术前影像学检查准确确定肿瘤侵犯范围；因此，应用了Retlap。尽管肿瘤进展，但Retlap使我们能够轻松识别并保护腹腔干根部和SMA。在确认可切除性后，进行了DP-CAR手术。
手术时间和估计失血量分别为841分钟和572毫升。术中冰冻切片证实使用Retlap获得了阴性手术切缘，实现了R0切除，术后病程顺利。
Retlap在技术上是可行的，对于实现DP-CAR的可切除性准确评估和微创性很有用。Retlap有助于为局部晚期胰腺癌病例提供最佳治疗效果。
