ObjectiveTo evaluate the effect of pathological portal vein (PV)/superior mesenteric vein (SMV) invasion during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma and the clinical significance of PD with PV/SMV resection in patients without pathological evidence of venous invasion.MethodsFrom January 1, 2013 to December 31, 2017, data of 183 patients who had PD for pancreatic adenocarcinoma were collected. Eighty-one patients had PD with PV/SMV resection for pancreatic adenocarcinoma, among them, 42 cases (51.9%) had pathological PV/SMV invasion (PD+P/S+ group) and 39 patients (48.1%) didn’t have pathological PV/SMV invasion (PD+P/S− group). One hundred and two patients had a standard PD without PV/SMV resection (control group). Multivariate analysis was used to identify predictive variables which influencing survival and the Kaplan-Meier method to estimate patients’ survival.ResultsThere were no differences in gender, age, preoperative serum CA19-9 level, blood loss, tumor size, tumor TNM stage, positive lymph nodes, ratio of positive lymph nodes, degree of tumor differentiation, perineural invasion, postoperative adjuvant chemotherapy, type of operation, and margin status among 3 groups (P>0.05). And moreover, no significant differences were found between the PD combined PV/SMV resection group and the control group in the incidence of complications and mortality (P>0.05) and all no reoperation happened. Univariate analysis revealed a significant difference in overall survival (OS) among the PD+P/S+ group, PD+P/S– group and control group (P<0.001), median survival time were 10, 19 and 20 months, respectivly. Moreover, depth of PV/SMV invasion, use of postoperative adjuvant chemotherapy and tumor differentiation were independent prognostic factors by multivariate survival analysis.ConclusionsOS of patients with PV/SMV invasion is significantly worse than that of patients without PV/SMV invasion, no matter underwent PV/SMV resection or not. The cause of that maybe invade to the tunica intima by tumor limits OS of patients with pancreatic adenocarcinoma. OS of PV/SMV-resected patients without pathological PV/SMV invasion is similar to that of patients who had standard PD without PV/SMV resection. Whether the patients can benefit from routine resection of PV/SMV is still controversial.
ObjectiveTo evaluate the effect of transecting the body of pancreas via inferior mesenteric vein (IMV) pathway during pancreaticoduodenectomy (PD) with venous resection. MethodsAccording to the inclusion and exclusion criteria, from February 1, 2016 to January 1, 2021, the patients who underwent PD with portal vein / superior mesenteric vein (PV/SMV) resection for resectable pancreatic adenocarcinoma were gathered. According to whether the traditional approach could be adopted to create a tunnel in front of the PV/SMV axis, the patients were allocated to the standard procedure group (S-group) or a modified procedure group (M-group). In the M-group, the patients who transected the pancreatic body via IMV pathway were allocated to the IMV-subgroup, while the patients who transected the pancreatic body via the left side of PV or in the middle of the pancreas were allocated to the central subgroup (C-subgroup). The clinicopathologic characteristics and survival (overall survival) were compared between the M-group and S-group, as well as between the IMV-subgroup and C-subgroup. The survival curve was drawn using Kaplan-Meier method for survival analysis, and the risk factors affecting overall survival by Cox proportional hazards regression model. ResultsA total of 142 patients were gathered, including 77 in the S-group, 65 in the M-group, 29 in the IMV-subgroup and 36 in the C-subgroup. The results of clinicopathologic data of patients among the different groups showed that the M-group had a more intraoperative bleeding (P＜0.001), longer postoperative hospital stay (P=0.021), and a proportion of vascular invasion (P=0.017), as well as the IMV-subgroup only had a higher proportion of vascular invasion (P=0.030) as compared with the S-group; At the same time, compared with the C-subgroup, the IMV-subgroup had a less intraoperative bleeding volume (P＜0.001) and a higher proportion of R0 resection (P=0.031). There were no statistically differences in other clinicopathologic data among the groups (P＞0.05). The analysis of survival curve by Kaplan-Meier method showed that the median overall survival (OS) of IMV-subgroup, C-subgroup, and S-group was 21, 17, and 22 months, respectively. The OS of IMV-subgroup was better than that of the C-subgroup (χ2=4.676, P=0.031), which had no statistical difference between the IMV-subgroup and S-group ( χ2=0.007, P=0.934). The multivariate analysis results showed that the patients with postoperative adjuvant chemotherapy [RR=0.519, 95%CI (0.324, 0.833), P=0.007] and with R0 margin [RR=0.434, 95%CI (0.218, 0.865), P=0.018] were the protective factors affecting the OS, while low tumor differentiation [RR=2.433, 95%CI (1.587, 3.730), P<0.001], PV/SMV pathological invasion [RR=2.788, 95%CI (1.543, 5.039), P=0.001], and tumor infiltration into PV/SMV intima [RR=1.838, 95%CI (1.062, 3.181), P=0.030] were the risk factors affecting the OS. ConclusionsThe results of this study suggest that, transecting the body of pancreas via IMV pathway can improve the rate of R0 resection, improve OS, and do not increase postoperative morbidity and mortality. It may provide a better selection for transecting the body of pancreas when the anterior PV/SMV and posterior surface of the neck of the pancreas are invaded by tumors or has inflammatory adhesion.
ObjectiveLymph node metastasis status directly influences surgical strategies for right-sided colon cancer. This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. MethodsA total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. ResultsOverall lymph node metastasis rate:42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3%(41/123), intermediate lymph node(N2) 10.6%(13/123), and central lymph node (N3) 13.8% (16/123). Cecal cancer: Ileocolic artery lymph node metastasis rate: 40.0% (10/25), right colic artery: 0% (0/6) and middle colic artery: 4.0% (1/25). Transverse colon cancer: Ileocolic artery lymph node metastasis rate: 0%(0/18) and middle colic artery: 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) with hepatic flexure cancer showed metastasis. No ileal lymph node metastasis was observed. N3 metastasis rates: 9.3% (8/86) in well/moderately differentiated tumors vs. 21.6% (8/37) in poorly differentiated tumors. No N3 lymph node metastasis occurred in T1～2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively. ConclusionsFor cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are very high, respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.