Retrograde artery first approach for “shoulder” pancreatic cancers in minimally invasive distal pancreatectomy

• Published in: Surgical endoscopy Vol. 35; no. 1; pp. 74 - 80
• Main Authors: Tian, Feng, Sun, Meng-qing, Lu, Jun, Guo, Jun-chao
• Format: Journal Article
• Language: English
• Published: New York Springer US 2021; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Dissection; Endoscopy; Fistula; Gastroenterology; Gynecology; Hepatology; Lymphatic system; Medicine; Medicine & Public Health; Mesentery; Pancreatectomy; Pancreatic cancer; Pathology; Proctology; Spleen; Surgery; Tumors; Veins & arteries; Retrograde artery first; Distal pancreatectomy; Minimally invasive; Shoulder pancreatic cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-07908-7

Background “Shoulder” pancreatic cancer, defined as tumor located at the confluence where the splenic vein meets the portal vein, has specific adjacent anatomies. It’s difficult to resect this type of tumor with adequate regional lymphadenectomy. Methods We described a new concept of “shoulder” pancreatic cancer, and retrospectively analyzed eleven consecutive cases from September 2019 to April 2020, to assess the safety and efficacy of the retrograde artery first approach in minimally invasive distal pancreatectomy. The primary outcome was set as radical (R0) resection rate. Results All of the 11 cases achieved R0 resection, with a median of 8 (range 5–32) lymph nodes harvested, given the ratio of embraced splenic vein in 72.7% of the cases, splenic artery embracement in 45.5%, and SMV–PV wall invasion in 27.3%. The maximum tumor size on pathology was 35 (range 20–65) mm. The median operative time was 260 (range 155–470) min, and the median estimated blood loss was 200 (range 50–1000) ml. One case needed intraoperative transfusion. One grade B postoperative pancreatic fistula occurred accompanied with abdominal infection, while the rest of cases recovered uneventful. The median postoperative length of stay was 9 (range 6–20) days. Conclusions “Shoulder” pancreatic cancers are clinically significant. Retrograde artery first approach is a potentially safe and effective alternative to achieve a radical resection margin for shoulder pancreatic cancers in minimally invasive era. More evidences are needed in the future.