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Purpose <p>The purpose of this study is to evaluate the efficacy of laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric artery (SMA) left posterior first approach and circumferential lymphadenectomy with total meso-pancreas (MP) dissection for periampullary malignancies.</p> Methods <p>31 patients who underwent LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection between September 2021 and September 2023. General characteristics, operative techniques, short-term outcomes and pathological results were prospectively evaluated.</p> Results <p>The mean operation time and SMA first-approach time were 441.9 ± 73.7&#xa0;min and 99.9 ± 27.7&#xa0;min, respectively. The median intraoperative blood loss was 143&#xa0;ml (range: 50–1500&#xa0;ml). The median number of total LNs and left-sided SMA LNs harvested were 32,7 ± 13 (16—74) and 7,4 ± 6 (range: 3—30), respectively. The rate of metastatic left-sided SMA LNs and meso-pancreas were 25.8% and 22.6%, respectively. 22.6% of patients had pancreatic fistula, but mostly in grade A, with only one case that required conversion. Only one case developed postoperative refractory diarrhea. The mean postoperative hospital stay was 14.1&#xa0;days. No 90-day mortality was reported.</p> Conclusion <p>LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection was safe and effective with favorable short-term outcomes.</p>

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Left posterior superior mesenteric artery first approach and circumferential lymphadenectomy with total mesopancreas dissection in laparoscopic pancreaticoduodenectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月3日

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  • Ham Hoi Nguyen,
  • Thanh Khiem Nguyen,
  • Tuan Hiep Luong,
  • Hai Dang Do,
  • Kim Khue Dang,
  • Van Duy Le,
  • Duc Dung Dao,
  • Van Minh Do,
  • Ngoc Hung Nguyen,
  • Hong Son Trinh,
  • Dang Vung Nguyen,
  • Yosuke Inoue

摘要

Purpose

The purpose of this study is to evaluate the efficacy of laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric artery (SMA) left posterior first approach and circumferential lymphadenectomy with total meso-pancreas (MP) dissection for periampullary malignancies.

Methods

31 patients who underwent LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection between September 2021 and September 2023. General characteristics, operative techniques, short-term outcomes and pathological results were prospectively evaluated.

Results

The mean operation time and SMA first-approach time were 441.9 ± 73.7 min and 99.9 ± 27.7 min, respectively. The median intraoperative blood loss was 143 ml (range: 50–1500 ml). The median number of total LNs and left-sided SMA LNs harvested were 32,7 ± 13 (16—74) and 7,4 ± 6 (range: 3—30), respectively. The rate of metastatic left-sided SMA LNs and meso-pancreas were 25.8% and 22.6%, respectively. 22.6% of patients had pancreatic fistula, but mostly in grade A, with only one case that required conversion. Only one case developed postoperative refractory diarrhea. The mean postoperative hospital stay was 14.1 days. No 90-day mortality was reported.

Conclusion

LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection was safe and effective with favorable short-term outcomes.