Ivor-Lewis Santi 食管切除术后的胰十二指肠切除术与胃管重建。欧洲多中心经验。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2024-09-20 DOI:10.1016/j.suronc.2024.102144

Alessandro D. Mazzotta , Pietro Addeo , Benedetto Ielpo , Michael Ginesini , Nicolas Regenet , Ugo Boggi , Philippe Bachellier , Olivier Soubrane

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引用次数: 0

摘要

背景：胰十二指肠切除术（PD）是治疗影响胰腺头部的肿瘤和其他疾病的标准手术。胰十二指肠切除术包括分割胃十二指肠动脉（GDA）及其分支，以便彻底切除淋巴结。然而，由于解剖结构的改变和损害胃管血管的风险，对曾进行过食管切除术的患者进行胃十二指肠切除术是一项挑战。保留 GDA 对避免缺血至关重要，但这可能会遗留区域淋巴结，从而带来肿瘤风险。本文回顾了欧洲外科中心在食管手术前患者中进行胃十二指肠切除术的经验和技术，重点关注短期疗效：我们收集了欧洲外科中心的所有经验，并评估了对曾接受过食管手术的患者进行腹腔镜手术的技术，同时分析了短期疗效：我们确定了来自欧洲 5 个中心的 8 名患者。结果：来自欧洲 5 个中心的 8 名患者被确诊为胰腺癌，其中包括 1 例边缘病例。术中，所有病例都保留了胃十二指肠动脉（GDA），只有一例因肿瘤侵犯而需要重建门静脉。手术过程中未发现胃管缺血或静脉充血。术后并发症包括1例（12.5%）POPF C型和1例（12.5%）PPH C型。切除淋巴结的中位数为 21 [14-24]，阳性淋巴结的中位数为 1.5。62.5%的病例进行了R1切除：结论：在 Ivor Lewis 食管切除术后进行胰腺十二指肠切除术是一项技术挑战，但在选定的患者中似乎可行且安全。保留胰腺十二指肠的胰腺切除术是传统手术的一种有价值、省时的变体，在肿瘤学上可被认为是适当的，但仍需研究证实其对根治性的长期影响。

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Pancreatoduodenectomy after Ivor-Lewis Santi oesophagectomy with gastric tube reconstruction. An European multicentre experience

Background

Pancreaticoduodenectomy (PD) is the standard surgery to treat tumors and other conditions affecting the head of the pancreas. PD involves the division of the gastroduodenal artery (GDA) and its branches, to allow for complete dissection of lymph nodes. However, PD in patients with prior esophageal resection presents challenges due to altered anatomy and risks compromising gastric tube vascularization. GDA preservation becomes crucial to avoid ischemia, although this may pose oncological risks by potentially leaving behind regional lymph nodes. This article reviews European surgical center experiences and techniques for PD in patients with prior esophageal surgery, focusing on short-term outcomes.

Methods

We have collected all the experiences carried out in European surgical centers and evaluated the techniques applied for PD in patients who had prior esophageal surgery while analyzing short-term outcomes.

Results

Eight patients from 5 European centers were identified. Six patients were diagnosed with pancreatic adenocarcinoma, including one borderline case. Intraoperatively, the gastroduodenal artery (GDA) was preserved in all cases, with portal vein reconstruction required in only one instance due to tumor invasion. No ischemia or venous congestion of the gastric tube was observed during the surgical procedure. Post-operative complications that occurred included POPF type C in 1 (12.5 %), PPH type C in 1 (12.5 %). The median number of harvested lymph nodes was 21 [14–24]. with a median of 1.5 positive lymph nodes. R1 resection was present in 62.5 % of cases.

Conclusion

Performing pancreaticoduodenectomy subsequent to Ivor Lewis esophagectomy is a technical challenge, but seems feasiable and safe in selected patients. GDA-preserving pancreaticoduodenectomy emerges as a valuable and time-efficient variation of the conventional procedure, it can be considered oncologically appropriate, but studies confirming its long-term impact on radicality are still needed.

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.