Application Of En-bloc Resection Strategy For The Pancreaticoduodenectomy Of Pancreatic Head Adenocarcinoma

Objective1.To summarize the En-bloc resection strategy and surgery procedures of pancreaticoduodenectomy(PD)for pancreatic head adenocarcinoma.2.To evaluate the efficacy and safety of PD with En-bloc resection strategy for pancreatic head adenocarcinoma.Methods1.Under the guidance of the chief surgeon and combined with surgical video and review of related literature,we summarize the En-bloc resection strategy and main surgery procedures of PD for pancreatic head adenocarcinoma.2.The clinicopathological data of 139 patients with pancreatic head adenocarcinoma who underwent PD from January 1,2013 to June 30,2016 in Department of Pancreatic Surgery,Changhai Hospital and Changzheng Hospital,Naval Military Medical University were reviewed retrospectively.The same surgical group performed PD with En-bloc resection strategy(En-PD)from July 1,2014 to June 30,2016 for 69 patients(En-PD group),and performed traditional PD(TPD)from January 1,2013 to June 30,2014 for 70 patients(TPD group).The operation time,intraoperative blood loss,TNM stage,surgical margin status,tumor size,number of lymph node,positive nodal ratio,postoperative length of hospital stay,postoperative morbidity and mortality,postoperative local recurrence rate,the median survival time,the overall survival time etc.of the two groups are collected and analyzed.Results1.The operation time and intraoperative blood loss between En-PD group and TPD group had no significant difference(P value were 0.017,0.016 respectively).There was no statistical significance in postoperative length of hospital stay,postoperative complications,and mortality between the En-PD group and the TPD group(P value were 0.592,0.810,1.000 respectively).2.Of the 30 borderline resectable cases,16(23.3%)underwent En-PD and 14(20.0%)underwent TPD,and the combined resection of PV/SMV didn't have statistical significance between the two groups(P=0.648).The R0 rate of the two groups was 91.3% and 94.3% respectively,and the positive rate of lymph nodes was 44.9% and 41.4% respectively,The difference had no statistical significance(P=0.532 P=0.677).However,the number of average lymph node resection(13.58±11.19)in the En-PD group was more than that of the TPD group(5.79±3.12),and the difference was statistically significant(P(27)0.001).3.The postoperative local recurrence and metastasis rates of the En-PD group and the TPD group were 29.0% and 45.7%,respectively,with statistical difference(P=0.042).The median survival time of the En-PD group was 19.8 months,and the 1-year survival rate and 2-year survival rate were 75.5% and 21.7% respectively.The median survival time of TPD group was 20.9 months,and the 1-year survival rate and 2-year survival rate were 72.9% and 24.3% respectively.There was no statistical y significant difference between the two groups(P=0.061).Conclusion1.En-bloc resection strategy applied in PD is safe and feasible in clinical practice.However,it is suggestted that En-PD should be performed in an experienced pancreatic surgery center,especially when the surgery of borderline resectable pancreatic cancer should be performed with PV/SMV excision and reconstruction.2.Compared with the TPD,the local recurrence rate of the En-PD was lower.3.Compared with the TPD,the En-PD had more resected lymph nodes,which is more beneficial to the removal of lymph nodes metastasis.4.The overall short-term outcome of pancreaticoduodenectomy with En-bloc resection strategy was satisfactory.It is worthy further exploration in the future clinical practice.