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New approach of circumferential lymph node dissection around the superior mesenteric artery for pancreatic cancer during pancreaticoduodenectomy (with video)

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Abstract

Purpose

Various approaches have been reported for the resection of the nervous and lymphatic tissues around the superior mesenteric artery (SMA) during pancreaticoduodenectomy (PD) for pancreatic cancer. We developed a new procedure for circumferential lymph node dissection around the SMA to minimize local recurrence.

Methods

We included 24 patients who underwent PD with circumferential lymph node dissection around the SMA (circumferential dissection) and 94 patients who underwent classical mesopancreatic dissection (classical dissection) between 2019 and 2021. The technical details of this new method are described in the figures and videos, and the clinical characteristics and outcomes of this technique were compared with those of classical dissection.

Results

The median follow-up durations in the circumferential and classical dissection groups were 39 and 36 months, respectively. The patients’ characteristics, including tumor resectability, preoperative and adjuvant chemotherapy rates, postoperative complication rates, and tumor stage, were similar between the two groups. No differences were observed in recurrence-free survival and overall survival between the two groups; however, the classical dissection group tended to have more local recurrences than the circumferential dissection group (8.3% vs. 33.3%, P = 0.168). Although no case of nodular-type recurrence after circumferential dissection was observed, 61.1% of local recurrences after classical dissection were of the nodular-type, and 36.4% were located on the left side of the SMA.

Conclusions

Performing circumferential lymph node dissection around the SMA during PD can be conducted safely with minimal risks of local recurrence and may enhance the completeness of local resection.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Editage (http://www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 1358550, Japan

    Yoshihiro Ono, Yosuke Inoue, Tomotaka Kato, Kosuke Kobayashi, Oba Atsushi, Takafumi Sato, Hiromichi Ito & Yu Takahashi

  2. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, 1358550, Japan

    Manabu Takamatsu

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  1. Yoshihiro Ono
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  2. Yosuke Inoue
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Contributions

Study conception and design: Y.O. and Y.T. Acquisition of data: Y.O., K.K., M.T., T.K., and Y.T. Analysis and interpretation of data: Y.O., Y.I., H.I., and Y.T. Drafting of the manuscript: Y.O. and Y.T. Critical revision of the manuscript: Y.I., T.K., A.O., T.S., and H.I.

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Correspondence to Yu Takahashi.

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Ono, Y., Inoue, Y., Kato, T. et al. New approach of circumferential lymph node dissection around the superior mesenteric artery for pancreatic cancer during pancreaticoduodenectomy (with video). Langenbecks Arch Surg 408, 422 (2023). https://doi.org/10.1007/s00423-023-03159-x

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