Safety and Feasibility of a Pancreaticoduodenectomy with Total Meso-Pancreatoduodenum Excision: Analysis in Various Periampullary Disorders

摘要

Background/Aims: This study aimed to evaluate the safety and feasibility of a pancreaticoduodenectomy with total meso-pancreatoduodenum excision (tMPDe) as an new anatomical concept. Methodology: A total of 90 patients underwent PD for various periampullary diseases. Of these, 52 patients received a conventional PD (cPD), while 38 patients underwent a tMPDe. Surgical outcomes were compared between the two study groups. Results: Operative time was equivalent in the two groups; however, the estimated blood loss [cPD, 1360ml ; tMPDe, 995ml; median, P=0.026) and blood transfusion rate (cPD, 63%; tMPDe, 31% ; P=0.001) were significantly decreased in tMPDe. Morbidity had no significant differ-ence between cPD and tMPDe, and tMPDe showed no characteristic complications. With regard to oncological aspects, tMPDe was superior to cPD. Risk factors analysis revealed the operative time (P=0.003], estimated blood loss (P<0.001], and blood transfusion [P<0.001] to be significant predictive risk factors for postoperative morbidity but not tMPDe procedure (P=0.794). Conclusions: tMPDe is safe and superior to cPD because it is a bloodless operation with a good oncological outcome. We concluded that tMPDe should be adaptable to various periampullary diseases, including benign and low-grade malignant disorders.