Background

Surgical resection is the mainstay of potential cure for patients with pancreatic cancer, however, local recurrence is frequent. Previously, we have described an extended resection technique for pancreatoduodenectomy aiming at a radical resection of the nerve and lymphatic tissue between celiac artery, superior mesenteric artery and mesenteric–portal axis (TRIANGLE operation). Until now, data on postoperative outcome have not been reported, yet.

Methods

Patients who underwent either partial (PD) or total pancreatoduodenectomy (TP) applying the TRIANGLE procedure were identified. These cohorts were compared to matched historic cohorts with standard resections.

Results

Overall, 330 patients were analysed (PD_TRIANGLE and PD_STANDARD, each n = 108; TP_TRIANGLE and TP_STANDARD, each n = 57). More lymph nodes were harvested in TRIANGLE compared to standard resection (PD: 27.5 (21–35) versus 31.5 (24–40); P = 0.0187, TP: 33 (28–49) versus 44 (29–53); P = 0.3174) and the rate of tumour positive resections margins, R1(direct), dropped. Duration of operation was significantly longer and blood loss higher. Postoperative mortality and complications did not differ significantly.

Conclusion

Pancreatoduodenectomy according to the TRIANGLE protocol can be performed without increased morbidity and mortality at a high-volume centre. Long-term survival and quality of life need to be investigated in prospective clinical trials with adequate sample size.

中文翻译：

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胰头癌和胰体癌的 TRIANGLE 手术：术后早期结果

背景

手术切除是胰腺癌患者潜在治愈的中流砥柱，但局部复发率较高。之前，我们已经描述了一种胰十二指肠切除术的扩展切除技术，旨在根治性切除腹腔动脉、肠系膜上动脉和肠系膜-门静脉轴之间的神经和淋巴组织（TRIANGLE 手术）。到目前为止，尚未报告有关术后结果的数据。

方法

确定了应用 TRIANGLE 手术接受部分 (PD) 或全胰十二指肠切除术 (TP) 的患者。将这些队列与标准切除的匹配历史队列进行比较。

结果

总体而言，分析了 330 名患者（PD _TRIANGLE和 PD _STANDARD，每个 n = 108；TP _TRIANGLE和 TP _STANDARD，每个 n = 57）。与标准切除相比，在 TRIANGLE 中收获了更多的淋巴结（PD：27.5（21-35）对 31.5（24-40）；P = 0.0187，TP：33（28-49）对 44（29-53）；P = 0.3174），肿瘤切缘阳性率 R1（直接）下降。手术时间明显更长，失血量更高。术后死亡率和并发症没有显着差异。

结论

根据 TRIANGLE 方案的胰十二指肠切除术可以在高容量中心进行，而不会增加发病率和死亡率。长期生存和生活质量需要在具有足够样本量的前瞻性临床试验中进行调查。