Surgical Technique of Pancreatic Parenchyma Transection-Delayed Approach (PPTDA) in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma

Naokazu Chiba, Yuta Abe, Kei Yokozuka, Kosuke Hikita, Toshimichi Kobayashi, Toru Sano, Koichi Tomita, Rina Tsutsui, Shigeyuki Kawachi

Research output: Contribution to journalArticle

Abstract

Background: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case. Technical Presentation: This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula. Conclusion: This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.

Original languageEnglish
JournalJournal of Gastrointestinal Surgery
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Klatskin Tumor
Pancreatic Fistula
Dissection
Bile Duct Neoplasms
Pancreaticoduodenectomy
Liver Failure
Hepatectomy
Bile Ducts
Pancreas
Neoplasms
Morbidity
Safety
Mortality
Liver

Keywords

  • Hilar cholangiocarcinoma
  • Pancreas parenchyma transection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Surgical Technique of Pancreatic Parenchyma Transection-Delayed Approach (PPTDA) in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma. / Chiba, Naokazu; Abe, Yuta; Yokozuka, Kei; Hikita, Kosuke; Kobayashi, Toshimichi; Sano, Toru; Tomita, Koichi; Tsutsui, Rina; Kawachi, Shigeyuki.

In: Journal of Gastrointestinal Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Chiba, Naokazu ; Abe, Yuta ; Yokozuka, Kei ; Hikita, Kosuke ; Kobayashi, Toshimichi ; Sano, Toru ; Tomita, Koichi ; Tsutsui, Rina ; Kawachi, Shigeyuki. / Surgical Technique of Pancreatic Parenchyma Transection-Delayed Approach (PPTDA) in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma. In: Journal of Gastrointestinal Surgery. 2018.
@article{c0a6bb6873124dea943aca84d4fc130a,
title = "Surgical Technique of Pancreatic Parenchyma Transection-Delayed Approach (PPTDA) in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma",
abstract = "Background: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case. Technical Presentation: This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula. Conclusion: This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.",
keywords = "Hilar cholangiocarcinoma, Pancreas parenchyma transection",
author = "Naokazu Chiba and Yuta Abe and Kei Yokozuka and Kosuke Hikita and Toshimichi Kobayashi and Toru Sano and Koichi Tomita and Rina Tsutsui and Shigeyuki Kawachi",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s11605-018-3923-6",
language = "English",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Surgical Technique of Pancreatic Parenchyma Transection-Delayed Approach (PPTDA) in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma

AU - Chiba, Naokazu

AU - Abe, Yuta

AU - Yokozuka, Kei

AU - Hikita, Kosuke

AU - Kobayashi, Toshimichi

AU - Sano, Toru

AU - Tomita, Koichi

AU - Tsutsui, Rina

AU - Kawachi, Shigeyuki

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case. Technical Presentation: This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula. Conclusion: This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.

AB - Background: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case. Technical Presentation: This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula. Conclusion: This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.

KW - Hilar cholangiocarcinoma

KW - Pancreas parenchyma transection

UR - http://www.scopus.com/inward/record.url?scp=85053269932&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053269932&partnerID=8YFLogxK

U2 - 10.1007/s11605-018-3923-6

DO - 10.1007/s11605-018-3923-6

M3 - Article

C2 - 30187328

AN - SCOPUS:85053269932

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

ER -