Nguyen Thanh Khiem, Nguyen Ham Hoi, Luong Tuan Hiep, Chantha Pisey, Le Van Duy, Do Dinh Toi, Do Viet Anh, Pham Hong Quang
Center of Digestive Surgery, Bach Mai Hospital, Hanoi, Vietnam.
Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.
Ann Hepatobiliary Pancreat Surg. 2025 Aug 31;29(3):353-361. doi: 10.14701/ahbps.25-064. Epub 2025 Jul 14.
We herein present a novel combined posterior and left-sided superior mesenteric artery (SMA) first approach to facilitate the TRIANGLE operation for pancreatoduodenectomy (PD) or total pancreatectomy (TP) in pancreatic cancer. Patients who were diagnosed with resectable pancreatic ductal adenocarcinoma who underwent PD or TP using the combined posterior and left-sided SMA-first approach to the TRIANGLE operation between June 2021 and June 2024 were included in this study. General characteristics, technical details including operative techniques, short-term outcomes, and pathological results were analyzed retrospectively and compared with those from historic cohorts undergoing single SMA-first approach resections. Overall, 126 patients were analyzed (dual-approach PD-TP, n = 33; single-approach PD-TP, n = 93). The dual-approach resection yielded more lymph nodes than the single-approach (36.17 vs 26.53; < 0.001). Additionally, the rate of tumor-positive resection margins, R1 (direct), was decreased. The duration of the operation was significantly longer, and blood loss was higher with the dual approach. There was no significant difference in postoperative mortality and complications between the two approaches. Utilizing the combined posterior and left-sided first approach to SMA in PD or TP with the TRIANGLE operation proved safe and effective for achieving R0 resection with favorable short-term outcomes in borderline resectable and locally advanced pancreatic cancer.
我们在此介绍一种新颖的联合后路和肠系膜上动脉左侧优先入路，以促进胰腺癌胰十二指肠切除术（PD）或全胰切除术（TP）的TRIANGLE手术。本研究纳入了2021年6月至2024年6月期间，采用联合后路和肠系膜上动脉左侧优先入路进行TRIANGLE手术，诊断为可切除胰腺导管腺癌并接受PD或TP的患者。回顾性分析患者的一般特征、包括手术技术在内的技术细节、短期结果和病理结果，并与接受单一肠系膜上动脉优先入路切除术的历史队列进行比较。总共分析了126例患者（双入路PD-TP，n = 33；单入路PD-TP，n = 93）。双入路切除术比单入路切除的淋巴结更多（36.17对26.53；<0.001）。此外，肿瘤阳性切缘（R1，直接）率降低。双入路手术时间明显更长，失血量更多。两种入路术后死亡率和并发症无显著差异。在PD或TP中采用联合后路和肠系膜上动脉左侧优先入路进行TRIANGLE手术，对于在临界可切除和局部晚期胰腺癌中实现R0切除并获得良好的短期结果，被证明是安全有效的。
