Fukada Masahiro, Mitsui Noriki, Horaguchi Takeshi, Hatanaka Yuji, Yasufuku Itaru, Sato Yuta, Tajima Jesse Yu, Kiyama Shigeru, Tanaka Yoshihiro, Murase Katsutoshi, Matsuhashi Nobuhisa
Department of Gastroenterological Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
World J Surg Oncol. 2025 Feb 4;23(1):36. doi: 10.1186/s12957-025-03700-w.
Minimally invasive left pancreatectomy (MILP) is increasingly performed worldwide, necessitating the need for improved understanding of vascular anatomy during surgery. However, the effect of differences in vascular anatomy on surgical outcomes remains unclear. In this study, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify factors that influence open and minimally invasive surgery (MIS) outcomes.
This was a single-center retrospective study involving 123 patients who underwent left pancreatectomy (LP). We analyzed the correlation between vascular anatomical variations, namely, (i) the root of the splenic artery (SpA; types 1 and 2), (ii) the parent artery of the dorsal pancreatic artery, (iii) confluence patterns of the left gastric vein, and (iv) the inferior mesenteric vein, and surgical outcomes. We also performed a risk analysis of prolonged operation time, considering surgery-related factors.
SpA type 2 was only significantly associated with longer operation time (p < 0.01) in LP procedures. In all LP cases, the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69-11.18; p < 0.01), the SpA type (type 2; OR 2.77; 95% CI 1.16-6.94; p = 0.02), and surgery type (MIS; OR 5.24; 95% CI 2.17-14.00; p < 0.001) were independently associated with prolonged operation times. In open-LP cases, high body mass index (> 24 kg/m; OR 7.24; 95% CI 1.89-36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79-33.79; p < 0.01), and the SpA type (type 2; OR 5.86; 95% CI 1.72-24.65; p < 0.01) showed significant association with prolonged operations. In MILP cases, sex (male; OR 9.07; 95% CI 2.61-38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18-17.08; p = 0.03) showed significant associations.
SpA type 2 may negatively affect surgical outcomes. Therefore, it is important to recognize and approach vascular anatomy appropriately. MIS, especially robotic surgery, may be effective in mitigating the negative effects of variations in vascular anatomy.
微创左胰切除术（MILP）在全球范围内的开展日益增多，这就需要在手术过程中更好地了解血管解剖结构。然而，血管解剖结构差异对手术结果的影响仍不明确。在本研究中，我们旨在评估血管解剖变异对手术结果的影响，并确定影响开放手术和微创手术（MIS）结果的因素。
这是一项单中心回顾性研究，纳入了123例行左胰切除术（LP）的患者。我们分析了血管解剖变异，即（i）脾动脉（SpA）根部（1型和2型）、（ii）胰背动脉的供血动脉、（iii）胃左静脉的汇合模式以及（iv）肠系膜下静脉与手术结果之间的相关性。我们还考虑手术相关因素，对手术时间延长进行了风险分析。
在LP手术中，仅SpA 2型与手术时间延长显著相关（p < 0.01）。在所有LP病例中，胰腺切除线（门静脉上方：比值比[OR] 3.47；95%置信区间[CI] 1.69 - 11.18；p < 0.01）、SpA类型（2型；OR 2.77；95% CI 1.16 - 6.94；p = 0.02）和手术类型（MIS；OR 5.24；95% CI 2.17 - 14.00；p < 0.001）与手术时间延长独立相关。在开放LP病例中，高体重指数（> 24 kg/m²；OR 7.24；95% CI 1.89 - 36.34；p < 0.01）、肿瘤位置（胰体；OR 6.89；95% CI 1.79 - 33.79；p < 0.01）和SpA类型（2型；OR 5.86；95% CI 1.72 - 24.65；p < 0.01）与手术时间延长显著相关。在MILP病例中，性别（男性；OR 9.07；95% CI 2.61 - 38.65；p < 0.001）和胰腺切除线（门静脉上方；OR 4.12；95% CI 1.18 - 17.08；p = 0.03）显示出显著相关性。
SpA 2型可能对手术结果产生负面影响。因此，正确识别和处理血管解剖结构非常重要。MIS，尤其是机器人手术，可能有效地减轻血管解剖变异的负面影响。
