[Cephalic duodenopancreatectomy in periampullary tumours. Dissection of the superior mesenteric artery as aninitial approach. Description of the technique and an assessment of our initial experience].
BACKGROUND
Pancreatoduodenectomy (PD) with initial dissection of the superior mesenteric artery (SMA) has been described as a useful technical variant to reduce blood loss and to avoid an unnecessary intervention in those cases with arterial involvement.


OBJECTIVE
To analyse the results of two recent technical modifications of PD introduced by our group: initial dissection of SMA and antecolic gastroenterostomy.


METHODS
Patients were divided into two groups: with and without initial dissection of the SMA. The results were also analysed according to the type of gastric reconstruction. Perioperative and long-term results are compared.


RESULTS
The overall mortality was 5%, with no significant differences between the initial SMA dissection and conventional PD. The transfusion rate (p < 0.001), the volume of blood products transfused (p = 0.001), and the overall complication rate were lower (p = 0.01) in the initial SMA dissection group. Also the postoperative hospital stay was significantly lower (p <or= 0.001). Despite a higher frequency of lymph node involvement in patients treated with initial SMA dissection (p = 0.001), the recurrence rate was similar between both groups. Among patients with initial SMA dissection, those who received antecolic reconstruction had a lower rate of delayed gastric emptying (p = 0.008).


CONCLUSIONS
Initial SMA dissection PD is a safe technique. The transfusion rate, morbidity and postoperative hospital stay are better when compared with conventional CPD. When an antecolic duodenal-jejunal reconstruction is associated, delayed gastric emptying cases are less frequent.
Figueras
Joan
J
Sección de Cirugía Hepatobiliar y Pancreática, Hospital Dr Josep Trueta, Girona, España. info@jfigueras.net
Codina-Barreras
Antonio
A
López-Ben
Santiago
S
Maroto
Albert
A
Torres-Bahí
Silvia
S
González
Héctor Daniel
HD
Albiol
Maite
M
Falgueras
Laia
L
Pardina
Berta
B
Soriano
Jorge
J
Codina-Cazador
Antonio
A
D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*