Lyu Shaocheng
Department of hepatobiliary surgery, Beijing Chaoyang Hospital, Capital medical university, No.8, Gongtinan road, Chaoyang District, Beijing, 100020, China.
Langenbecks Arch Surg. 2025 Aug 29;410(1):256. doi: 10.1007/s00423-025-03803-8.
To evaluate the value of mesenteric approach for borderline resectable pancreatic head cancer(BRPHC).
According to the inclusion and exclusion criteria, the data of 203 patients with borderline resectable pancreatic head cancer(BRPHC) who underwent radical pancreatoduodenectomy in our center from January 2011 to December 2023 were retrospectively analyzed. After detecting the superior mesenteric artery in infracolic compartment to judge that there was vascular invasion but it met the borderline resection criteria, the blood supply was cut off first, then the tissues and organs were resected. And the invaded vessels were resected and reconstructed or replaced, then conventional anastomosis was performed. All patients were divided into mesenteric approach group and conventional approach group according to the operation method. The outcome measures were operation completion, perioperative conditions and overall prognosis. The follow-up time was up to February 2025.
All 203 patients successfully completed the operation without perioperative death, and confirmed as pancreatic ductal adenocarcinoma by pathological examination. Overall and grouped prognosis: The overall survival rates and disease-free survival rates of 1-, 2-, and 5-year were 51.9%, 25.0%, 8.5% and 28.4%, 12.9%, 3.9% (Fig. 1). The 1-, 2-, and 5-year survival rates of patients in two groups were 62.1%, 40.3%, 21.7% and 44.1%, 14.7%, 1.8% (P = 0.000, X = 20.927) (Fig. 2A); The 1-, 2-, and 5-year disease-free survival rates in two groups were 44.9%, 24.5%, 8.2% and 20.8%, 7.5%, 1.9% (P = 0.006, X = 7.457) (Fig. 2B).
The mesenteric approach in infracolic compartment can improve the prognosis of patients with borderline resectable pancreatic head cancer, prolong the postoperative survival time of patients, and reduce the recurrence.
评估肠系膜入路在临界可切除胰头癌（BRPHC）中的应用价值。
根据纳入和排除标准，回顾性分析2011年1月至2023年12月在本中心接受根治性胰十二指肠切除术的203例临界可切除胰头癌（BRPHC）患者的数据。在结肠下区探测肠系膜上动脉，判断存在血管侵犯但符合临界切除标准后，先切断血供，再切除组织器官。切除受侵血管并进行重建或置换，然后进行常规吻合。根据手术方式将所有患者分为肠系膜入路组和传统入路组。观察指标为手术完成情况、围手术期状况及总体预后。随访至2025年2月。
203例患者均成功完成手术，无围手术期死亡，病理检查确诊为胰腺导管腺癌。总体及分组预后：1年、2年和5年的总生存率分别为51.9%、25.0%、8.5%，无病生存率分别为28.4%、12.9%、3.9%（图1）。两组患者1年、2年和5年生存率分别为62.1%、40.3%、21.7%和44.1%、14.7%、1.8%（P = 0.000，X = 20.927）（图2A）；两组1年、2年和5年无病生存率分别为44.9%、24.5%、8.2%和20.8%、7.5%、1.9%（P = 0.006，X = 7.457）（图2B）。
结肠下区肠系膜入路可改善临界可切除胰头癌患者的预后，延长患者术后生存时间，降低复发率。
