Maharjan Dhiresh Kumar, Pudasaini Prashanta, Acharya Bidur Prasad, Limbu Yugal, Ghimire Roshan, Thapa Prabin Bikram
Department of Gastrointestinal and General Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2025 Feb;63(282):103-108. doi: 10.31729/jnma.8887. Epub 2025 Feb 28.
The "TRIANGLE operation" involves the en-bloc removal of the tumor and the entire "mesopancreas" from the triangle-shaped space bounded by the superior mesenteric artery, coeliac trunk, and portal vein. This study assessed lymph node yield in apical tissue during the triangle operation.
An observational cross-section study was conducted for two years at the Department of Gastrointestinal and General Surgery at a tertiary care center of Nepal. from 15th March 2022 to 15th March 2024. The operative procedure included pancreaticoduodenectomy or Whipple's operation. Total sampling was done. Postoperative outcome and lymph node yeild of the surgeries were studied. Ethical approval was taken from the Institutional Review Committee (Reference No-1102202204).
A total of 56 patients underwent pancreaticoduodenectomy along with a triangle operation. The mean age of the patients was 56.38±14.79 years. Male: Female ratio was 1.2:1. Mean preoperative BMI was 24.41±4.72. The mean total lymph node yield was 20.95±8.57. Nineteen patients had a positive lymph node yield in the triangle tissue. The mean triangle lymph node yield was 10.59±4.92, and the mean positive lymph node was 2.58±1.64. Among 56 patients, nine patients had both apical margin and the rest of the triangle tissue margin positive. Ten patients had negative apical tissue margins, but the rest of the triangle tissue was positive, whereas, in thirty-seven patients, both the apical tissue and the rest of the triangle circumferential resection margin tissue were negative.
This study emphasizes the importance of the inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk to achieve R0 resection. However, a long-term follow is awaited.
“三角手术”包括将肿瘤和整个“中胰”从由肠系膜上动脉、腹腔干和门静脉界定的三角形空间整块切除。本研究评估了三角手术中尖部组织的淋巴结获取情况。
在尼泊尔一家三级医疗中心的胃肠和普通外科进行了为期两年的观察性横断面研究。从2022年3月15日至2024年3月15日。手术方式包括胰十二指肠切除术或惠普尔手术。进行了全样本采集。研究了手术的术后结果和淋巴结获取情况。获得了机构审查委员会的伦理批准（参考编号-1102202204）。
共有56例患者接受了胰十二指肠切除术及三角手术。患者的平均年龄为56.38±14.79岁。男女比例为1.2:1。术前平均体重指数为24.41±4.72。平均总淋巴结获取数为20.95±8.57。19例患者三角组织的淋巴结获取为阳性。三角淋巴结平均获取数为10.59±4.92，平均阳性淋巴结数为2.58±1.64。在56例患者中，9例患者的尖部切缘和三角组织其余部分切缘均为阳性。10例患者尖部组织切缘阴性，但三角组织其余部分为阳性，而在37例患者中，尖部组织和三角圆周切除缘组织其余部分均为阴性。
本研究强调了在肠系膜上动脉和腹腔干汇合处进行尖部组织清扫以实现R0切除的重要性。然而，尚需长期随访。
