Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 12, Number 5, October 2019, pages 256-262

Pancreaticoduodenectomy With Arterial Approach of Total Mesenteric Resection of the Pancreas for Pancreatic Head Cancer

Figure 1. Preoperative computed tomography findings of pancreatic head cancer without invasion of the venous system (a) or with invasion of the venous system (b).

Figure 2. PD with TMpE resection (a, b). Surgical procedures are described in the Methods section. PD: pancreaticoduodenectomy; TMpE: mesopancreas excision; SMV: superior mesenteric vein; SMA: superior mesenteric artery; PV: portal vein; CT: coeliacus truncus; LRV: left renal vein; MP: mesopancreas.

**Table 1.** Intra-Operative Operation Time and Bleeding Volume Observation (Mean ± SEM, n = 28 in Group A, n = 32 in Group B)
Groups	Operation time (min)	Intra-operative blood loss (mL)
Group A is the PD group with TMpE resection, and group B is the traditional PD group. SEM: standard error of mean; PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.001.
Group A	321.43 ± 43.03	366.07 ± 109.76
Group B	333.66 ± 29.77	557.81 ± 119.89
T value	-1.262	-6.427
P value	0.213	< 0.001*

Table 1. Intra-Operative Operation Time and Bleeding Volume Observation (Mean ± SEM, n = 28 in Group A, n = 32 in Group B)

Groups

Operation time (min)

Intra-operative blood loss (mL)

Group A is the PD group with TMpE resection, and group B is the traditional PD group. SEM: standard error of mean; PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.001.

Group A

321.43 ± 43.03

366.07 ± 109.76

Group B

333.66 ± 29.77

557.81 ± 119.89

T value

-1.262

-6.427

P value

0.213

< 0.001*

**Table 2.** R0 Resection Rate of Postoperative Specimen Pathology (n = 28 in Group A, n = 32 in Group B)
Groups	R0 cut number	R0 resection rate
Group A is the PD group with TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.05.
Group A (24/28)	24	85.71%
Group B (20/32)	20	62.50%
X²	4.115
P value	0.042*

Table 2. R0 Resection Rate of Postoperative Specimen Pathology (n = 28 in Group A, n = 32 in Group B)

Groups

R0 cut number

R0 resection rate

Group A is the PD group with TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.05.

Group A (24/28)

85.71%

Group B (20/32)

62.50%

X²

4.115

P value

0.042*

**Table 3.** Comparison of Postoperative Complications (n = 28 in Group A, n = 32 in Group B)
Groups	Total	Incidence rate	Infection	Postoperative bleeding	Pancreatic fistula	Biliary fistulae	Diarrhea	Delayed gastric emptying
Group A is the PD group with arterial priority approach TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision.
Group A	7	25.00% (7/28)	1	0	2	0	3	1
Group B	9	28.13% (9/32)	2	1	2	0	2	2
X²	0.075
P value	0.785

Table 3. Comparison of Postoperative Complications (n = 28 in Group A, n = 32 in Group B)

Groups

Total

Incidence rate

Infection

Postoperative bleeding

Pancreatic fistula

Biliary fistulae

Diarrhea

Delayed gastric emptying

Group A is the PD group with arterial priority approach TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision.

Group A

25.00% (7/28)

Group B

28.13% (9/32)

X²

0.075

P value

0.785

**Table 4.** Postoperative Tumor Recurrence (n = 28 in Group A, n = 32 in Group B)
Groups	Three months after surgery	Six months after surgery	Twelve months after surgery
Group A is the PD group with TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.05.
Group A	0	1	2
Group B	1	4	9
X²		0.609	4.391
P value	1	0.435	0.036*

Table 4. Postoperative Tumor Recurrence (n = 28 in Group A, n = 32 in Group B)

Groups

Three months after surgery

Six months after surgery

Twelve months after surgery

Group A is the PD group with TMpE resection, and group B is the traditional PD group. PD: pancreaticoduodenectomy; TMpE: total mesopancreas excision. *P < 0.05.

Group A

Group B

X²

0.609

4.391

P value

0.435

0.036*