Advantages of mesenteric approach to pancreatoduodenectomy for pancreatic head cancer with invasion of great vessels
- Authors: Abgaryan M.G.1, Kotelnikov A.G.1, Polyakov A.N.1, Avdyukhin I.G.1, Egenov O.A.1, Sun H.1, Stilidi I.S.1
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Affiliations:
- N.N. Blokhin National Medical Research Center of Oncology
- Issue: Vol 10, No 3 (2025)
- Pages: 232-236
- Section: Oncology and radiotherapy
- URL: https://journal-vniispk.ru/2500-1388/article/view/312154
- DOI: https://doi.org/10.35693/SIM687668
- ID: 312154
Cite item
Abstract
Aim – to compare standard and mesenteric approaches to surgical treatment of patients with pancreatic head cancer invading the portal and/or superior mesenteric veins and to evaluate their advantages.
Material and methods. Surgical treatment of 192 patients with pancreatic head cancer with portal and/or superior mesenteric vein invasion was performed. In 43 (22.4%) cases, pancreatoduodenal resection was performed through the mesenteric approach, in the remaining 149 (77.3%) patients, the standard approach to surgical treatment was used.
Results. The median duration of operations with the mesenteric approach was 290 min., with the standard one, 300 min., the median blood loss was 1120 ml and 1800 ml, respectively, p=0.0002. No statistically significant differences in the long-term treatment results were found for mesenteric and standard approaches: progression of pancreatic head adenocarcinoma was diagnosed in 48.8% and 49%, respectively; the median overall survival was 24.5 months and 22.3 months; the median progression-free survival was 21.3 months and 22.1 months, respectively. Analysis of long-term treatment results depending on the type of approach and the degree of radicality of surgical intervention showed that the incidence of local relapse with standard access in non-radically operated patients is significantly higher (40.6% vs 7.7%, p = 0.001).
Conclusion. The advantages of the mesenteric approach over the standard approach to surgical treatment of patients with pancreatic head cancer with portal and/or superior mesenteric vein invasion are as follows: 1) it makes it possible to assess the prevalence and operability of the tumor as early as at the beginning of the surgical intervention; 2) it ensures a significantly higher frequency of operations in the R0 volume; 3) it ensures significantly less blood loss during surgery; 4) after circular resection of the main veins it provides more opportunities to perform end-to-end plastic surgery, which reduces the risk of thrombosis due to the formation of only one anastomosis and reduces the time of clamping of the main veins, reducing the risk of liver and intestinal ischemia.
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##article.viewOnOriginalSite##About the authors
Mikael G. Abgaryan
N.N. Blokhin National Medical Research Center of Oncology
Email: abgaryan.mikael@gmail.com
ORCID iD: 0000-0001-8893-1894
Cand. Sci. (Medicine), Senior Researcher, Oncologist of the Department of Abdominal Oncology No. 1 of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowAleksei G. Kotelnikov
N.N. Blokhin National Medical Research Center of Oncology
Email: kotelnikovag@mail.ru
ORCID iD: 0000-0002-2811-0549
Dr. Sci. (Medicine), Leading Researcher of the Department of Abdominal Oncology No. 2 (Hepatopancreatobiliary Zone Tumors) of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowAleksandr N. Polyakov
N.N. Blokhin National Medical Research Center of Oncology
Email: dr.alexp@gmail.com
ORCID iD: 0000-0001-5348-5011
Cand. Sci. (Medicine), Senior Researcher of the Department of Abdominal Oncology No. 2 (Hepatopancreatobiliary Zone Tumors) of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowIvan G. Avdyukhin
N.N. Blokhin National Medical Research Center of Oncology
Email: ivan.avdyukhin@yandex.ru
ORCID iD: 0000-0002-3524-1037
oncologist of the Department of Abdominal Oncology No. 1 of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowOmar A. Egenov
N.N. Blokhin National Medical Research Center of Oncology
Author for correspondence.
Email: egenov.omar@mail.ru
ORCID iD: 0000-0002-8681-7905
Cand. Sci. (Medicine), Oncologist, Department of the Abdominal Oncology No. 2 (Hepatopancreatobiliary Zone Tumors) of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowHenian Sun
N.N. Blokhin National Medical Research Center of Oncology
Email: sunalaric@gmail.com
ORCID iD: 0000-0001-5574-0047
oncologist of the Department of Abdominal Oncology No. 1 of the N.N. Trapeznikov Research Institute of Clinical Oncology
Russian Federation, MoscowIvan S. Stilidi
N.N. Blokhin National Medical Research Center of Oncology
Email: biochimia@yandex.ru
ORCID iD: 0000-0002-0493-1166
Academician of the Russian Academy of Sciences, Dr. Sci. (Medicine), Director
Russian Federation, MoscowReferences
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