Pancreatic resection for metastatic tumors to the pancreas

Abstract

The incidence of R1 resection is high in pancreatic cancer despite of a good quality surgery. Amongst various techniques of mesopancreas excision, SMD is applicable to pancreatic and other periampullary carcinoma. This study has been conducted to compare the perioperative outcomes, the lymph node yield and the margin status in patients who underwent standard pancreaticoduodenectomy and SMD pancreaticoduodenectomy for pancreatic and periampullary carcinoma. Methods: A retrospective comparative study was conducted in a single unit of Gastrointestinal and Hepatopancreatobiliary surgery at Tribhuvan University Teaching Hospital, Nepal. The demographics, indication of surgery, duration of surgery, intraoperative blood loss, incidence of procedure-specific complications according to ISGPS, length of hospital stay, perioperative mortality, lymph node yield and margin status were compared. Results: Total of 17 patients underwent SMD pancreaticoduodenectomy. The demographic data was comparable with the historical data of 45 patients who underwent standard pancreaticoduodenectomy. The duration of surgery was longer in SMD pancreaticoduodenectomy (354.7AE51.1 mins vs 276.2 AE 43.1 mins), however, the blood loss was less (502.9 AE 178.1 ml vs 701.1 AE 354.6 ml). The incidence of POPF and perioperative mortality were less as compared to the patients who underwent standard pancreaticoduodenectomy (11.5% vs 14.6% and 5.9% vs 8.5% respectively). The rate of margin negative resection was comparable (88.2% vs 90%). The median lymph node yield was significantly high in patients who underwent SMD pancreaticoduodenectomy (15 vs 6, p < 0.05). Conclusion: SMD pancreaticoduodenectomy is feasible and should be performed not only for pancreatic carcinoma but also for other periampullary carcinoma.