Abstract
Introduction
Pancreatoduodenectomy is the standard procedure for duodenal carcinoma of the third or fourth portion. As an alternative option, we developed a novel segmental resection (SR) with partial mesopancreatic and mesojejunal excision (pMME) that enhances radicality. In this report, the surgical technique with video and outcomes are described.
Method
We performed SR with pMME on seven consecutive patients with third or fourth duodenal carcinoma between 2009 and 2021. We divided the procedure into four sections, including (1) wide Kocher’s maneuver, (2) supracolic anterior artery-first approach, (3) dissection of the mesopancreas and mesojejunum, and (4) devascularization of the uncinate process and dissection of duodenum.
Result
Median operative time was 348 min (range, 222–391 min), and median blood loss was 100 mL (range, 30–580 mL). Major complications of Clavien-Dindo classification grade 3a or more occurred in one patient. All patients achieved R0 resections with 10 mm or more proximal margin. Six cases (85%) were alive without recurrence.
Conclusion
We developed a radical and safe procedure of SR with pMME as an alternative and less invasive approach for duodenal carcinoma of the third or fourth portion.
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Abbreviations
- PD:
-
Pancreatoduodenectomy
- SR:
-
Segmental resection
- pMME:
-
Partial mesopancreatic and mesojejunal excision
- SMV:
-
Superior mesenteric vein
- SMA:
-
Superior mesenteric artery
- IPDA:
-
Inferior pancreatoduodenal artery
- JA:
-
Jejunal artery
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Study conception and design: R.I, M.Y, Y.T, Y.I, A.S. Acquisition of data: R.I. Analysis and interpretation of data: R.I, M.Y, A.S. Drafting of manuscript: R.I, M.Y. Critical revision of manuscript: Y.T, Y.I, A.S.
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Our institutional review board approved this retrospective study with waived informed consent. All authors have no conflicts of interest or financial ties to disclose.
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Ito, R., Mise, Y., Takahashi, Y. et al. Segmental resection with partial mesopancreatic and mesojejunal excision (pMME) for duodenal carcinoma of the third or fourth portion. Langenbecks Arch Surg 407, 2143–2150 (2022). https://doi.org/10.1007/s00423-022-02569-7
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DOI: https://doi.org/10.1007/s00423-022-02569-7