Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
HPB (Oxford). 2022 Mar;24(3):332-341. doi: 10.1016/j.hpb.2021.06.432. Epub 2021 Jul 6.
Surgical resection is the mainstay of potential cure for patients with pancreatic cancer, however, local recurrence is frequent. Previously, we have described an extended resection technique for pancreatoduodenectomy aiming at a radical resection of the nerve and lymphatic tissue between celiac artery, superior mesenteric artery and mesenteric-portal axis (TRIANGLE operation). Until now, data on postoperative outcome have not been reported, yet.
Patients who underwent either partial (PD) or total pancreatoduodenectomy (TP) applying the TRIANGLE procedure were identified. These cohorts were compared to matched historic cohorts with standard resections.
Overall, 330 patients were analysed (PD and PD each n = 108; TP and TP each n = 57). More lymph nodes were harvested in TRIANGLE compared to standard resection (PD: 27.5 (21-35) versus 31.5 (24-40); P = 0.0187, TP: 33 (28-49) versus 44 (29-53); P = 0.3174) and the rate of tumour positive resections margins, R1(direct), dropped. Duration of operation was significantly longer and blood loss higher. Postoperative mortality and complications did not differ significantly.
Pancreatoduodenectomy according to the TRIANGLE protocol can be performed without increased morbidity and mortality at a high-volume centre. Long-term survival and quality of life need to be investigated in prospective clinical trials with adequate sample size.
手术切除是胰腺癌患者潜在治愈的主要手段，然而，局部复发很常见。此前，我们描述了一种胰十二指肠切除术的扩展切除技术，旨在根治腹腔干、肠系膜上动脉和肠系膜门静脉轴之间的神经和淋巴组织（TRIANGLE 手术）。到目前为止，尚未报告术后结果的数据。
确定接受 TRIANGLE 手术行部分胰十二指肠切除术（PD）或全胰十二指肠切除术（TP）的患者。这些队列与标准切除的匹配历史队列进行比较。
总共分析了 330 名患者（PD 和 PD 各 n=108；TP 和 TP 各 n=57）。与标准切除术相比，TRIANGLE 手术中采集的淋巴结更多（PD：27.5（21-35）与 31.5（24-40）；P=0.0187，TP：33（28-49）与 44（29-53）；P=0.3174），且肿瘤阳性切缘（直接）R1 率下降。手术时间显著延长，出血量增加。术后死亡率和并发症无显著差异。
在高容量中心，根据 TRIANGLE 方案进行胰十二指肠切除术不会增加发病率和死亡率。需要在具有足够样本量的前瞻性临床试验中研究长期生存和生活质量。
