Total meso-pancreatoduodenum excision with pancreaticoduodenectomy in lower biliary tract cancer.
BACKGROUND
Incomplete tumor resection with insufficient lymphadenectomy following a pancreaticoduodenectomy (PD) for lower biliary tract cancer results in a dismal outcome. This study aimed to compare the short-term outcomes of PD between total meso-pancreatoduodenum excision (tMPDe) and the conventional procedure for lower biliary tract cancer.


METHODS
Patients who underwent PD for lower biliary tract cancer between May 2003 and March 2015 were included in this study. We have devised a new surgical technique, tMPDe, as a mesenteric plane surgery with an artery-first approach, for achieving complete clearance of the peripancreatic retroperitoneal tissue and lymph nodes. Perioperative data, including complications and short-term survival, were evaluated.


RESULTS
A total of 74 consecutive patients underwent a PD: 41 patients underwent conventional PD (cPD), and 33 underwent tMPDe. The tumor stages were similar in the two study groups. R0 was achieved in 32 patients (78.0 %) with cPD and in 31 patients (93.9 %) with tMPDe (p = 0.046). The survival rates at 1 and 3 years after surgery were 82.5 and 64.0 % for the cPD group, with a median follow-up period of 44.6 months, and 92.8 and 84.4 % for the tMPDe group, with a median follow-up period of 28.6 months, respectively.


CONCLUSIONS
The tMPDe technique significantly increased R0 resection and contributed to better oncological outcomes in lower biliary tract cancer.
Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan. manyu3310@yahoo.co.jp.
Yasunari
Y
Kawabata
Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan.
Hikota
H
Hayashi
Department of Organ Pathology, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan.
Noriyoshi
N
Ishikawa
Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan.
Yoshitsugu
Y
Tajima
D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Artery-first approach; Lower biliary tract cancer; Mesenteric plane surgery; Meso-pancreatoduodenum; Pancreaticoduodenectomy